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Sjöbom U, Hellqvist T, Humayun J, Nilsson AK, Gyllensten H, Hellström A, Löfqvist C. Circulating VEGF-A Levels in Relation to Retinopathy of Prematurity and Treatment Effects: A Systematic Review and Meta-Analysis. OPHTHALMOLOGY SCIENCE 2024; 4:100548. [PMID: 39184225 PMCID: PMC11342886 DOI: 10.1016/j.xops.2024.100548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/18/2024] [Accepted: 04/29/2024] [Indexed: 08/27/2024]
Abstract
Topic Retinopathy of prematurity (ROP) is a severe retinal vascular disorder affecting preterm infants, potentially leading to retinal detachment and blindness. This review aims to elucidate the relationship between systemic VEGF levels and ROP. Clinical Relevance This systematic review aims to consolidate evidence from available studies to guide future research and inform clinical practice. In particular, the role of circulating VEGF-A levels in predicting ROP onset and progression, and evaluating the impact of anti-VEGF therapy on these levels, is crucial in ensuring efficacy and safety in patient care. Methods Scopus and PubMed were searched to identify studies investigating circulating VEGF-gene products in ROP patients using immunologic assays. Two authors independently screened the literature and extracted data, employing a random-effects meta-analysis to compare VEGF levels as the ratio of means between ROP patients and controls before and after treatment, heterogeneity was reported by I2-statistics. Risks of bias and publication bias were assessed using Quality Assessment of Diagnostic Accuracy Studies-2 and funnel plots/Egger's tests, respectively. Results Out of 941 papers, 54 were included, with 26 providing posttreatment data and 31 providing biomarker data. Findings show a significant decrease in VEGF-A levels in the first week after ROP treatment (ratio of means [95% confidence interval] 0.34 [0.25-0.45], I2 = 97%, 17 publications). Anti-VEGF therapy showed a significantly more pronounced decrease (0.31 [0.25-0.38], I2 = 40%, 7 publications) than laser treatment in the first week after treatment (0.77 [0.61-0.97], I2 = 42%, 2 publications, subgroup difference, P < 0.01), among studies with a low risk of bias. Serum samples demonstrated a more marked decrease in VEGF-A than plasma (subgroup difference P < 0.01). However, the use of blood VEGF-A concentration as a biomarker for ROP prediction has shown inconsistent trends. The risk of bias mainly stems from unclear patient selection and lack of sample timing or analytical method details. Conclusion While anti-VEGF treatment significantly reduced blood VEGF-A levels in the first week post-ROP treatment, blood VEGF-A levels did not consistently predict ROP development. Heterogeneity in the results underscores the need for optimized analytical methods and emphasizes the importance of considering individual variation in VEGF-A concentrations independent of ROP diagnosis. Financial Disclosures The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Ulrika Sjöbom
- Learning and Leadership for Health Care Professionals At the Institute of Health and Care Science at Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Neuroscience At the Institution of Neuroscience and Physiology at Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Tove Hellqvist
- Department of Clinical Neuroscience At the Institution of Neuroscience and Physiology at Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jhangir Humayun
- Learning and Leadership for Health Care Professionals At the Institute of Health and Care Science at Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Anders K. Nilsson
- Department of Clinical Neuroscience At the Institution of Neuroscience and Physiology at Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Hanna Gyllensten
- Learning and Leadership for Health Care Professionals At the Institute of Health and Care Science at Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Ann Hellström
- Department of Clinical Neuroscience At the Institution of Neuroscience and Physiology at Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Chatarina Löfqvist
- Learning and Leadership for Health Care Professionals At the Institute of Health and Care Science at Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Neuroscience At the Institution of Neuroscience and Physiology at Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Tian Y, Fan Z, Zeng X, Yu Z, Lu X, Zhao X, Wu Z, He H, Zeng J, Zheng L, Zhang L, Correa VSMC, Ying G, Zhang S, Zhang G. Long-term follow-up of the cognitive function in children after intravitreal ranibizumab for retinopathy of prematurity. Graefes Arch Clin Exp Ophthalmol 2024; 262:3117-3124. [PMID: 38643422 DOI: 10.1007/s00417-024-06486-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 03/26/2024] [Accepted: 04/04/2024] [Indexed: 04/22/2024] Open
Abstract
PURPOSE To evaluate the long-term cognitive function in children treated with intravitreal ranibizumab (IVR) for retinopathy of prematurity(ROP), and the impact of IVR on the growth and ocular development. METHODS In this retrospective study, the premature children aged 4 to 9 years who received monotherapy of IVR (IVR group, n = 25) or monotherapy of laser photocoagulation (LP) (LP group, n = 33) for ROP, and the same age premature children with no ROP (Control group, n = 26) were enrolled from 2020 to 2022 in the pediatric fundus clinic of Shenzhen Eye Hospital. Main outcome measures were full-scale intelligence quotient (FSIQ) and index score using the Chinese version of the Wechsler intelligence scale for children-fourth edition (WISC-IV) and Wechsler preschool and primary scale of intelligence-fourth edition (WPPSI-IV). All children were examined and analyzed for growth and ocular development by recording the height, weight, head circumference, spherical equivalent (SE), best corrected visual acuity (BCVA) and axial length (AL). RESULTS There were 17 children in IVR group, 17 in LP group, and 11 in Control group who received the WISC-IV assessment. There were no significant differences in FSIQ, verbal comprehension index, perceptual reasoning index, working memory index, processing speed index, general ability index and cognitive efficiency index among the three groups. There were 8 children in IVR group, 16 in LP group, and 15 in Control group who received the WPPSI-IV assessment. There were no significant differences in FSIQ, verbal comprehension index, visuospatial index, fluid reasoning index, working memory index, non-verbal index, general ability index and cognitive efficiency index among the three groups. There was no significant difference in BCVA among the three groups (P = 0.74), however, there is an increase for AL in IVR group when compared with LP group (22.60 ± 0.58 vs. 22.13 ± 0.84, P = 0.003), and the ROP patients of IVR group have a significant increase in the AL compared to the Control group(22.60 ± 0.58 vs. 22.03 ± 0.71, P < 0.0001). CONCLUSIONS Children with a history of IVR have a similar cognitive function outcomes compared to those with a history of LP or were premature without ROP. ROP children with a history of IVR has longer AL than those treated with LP.
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Affiliation(s)
- Ya Tian
- Department of Ophthalmology, Guizhou Provincial People's Hospital, 18 Zhongshan East Road, Guiyang, 550002, Guizhou, China
| | - Zixin Fan
- Department of Pediatric Retinal Surgery, Shenzhen Eye Hospital, 18 Zetian Road, Shenzhen, 518040, Guangdong, China
| | - Xianlu Zeng
- Department of Pediatric Retinal Surgery, Shenzhen Eye Hospital, 18 Zetian Road, Shenzhen, 518040, Guangdong, China
| | - Zhen Yu
- Department of Pediatric Retinal Surgery, Shenzhen Eye Hospital, 18 Zetian Road, Shenzhen, 518040, Guangdong, China
| | - Xiaofeng Lu
- Department of Pediatric Retinal Surgery, Shenzhen Eye Hospital, 18 Zetian Road, Shenzhen, 518040, Guangdong, China
| | - Xinyu Zhao
- Department of Pediatric Retinal Surgery, Shenzhen Eye Hospital, 18 Zetian Road, Shenzhen, 518040, Guangdong, China
| | - Zhenquan Wu
- Department of Pediatric Retinal Surgery, Shenzhen Eye Hospital, 18 Zetian Road, Shenzhen, 518040, Guangdong, China
| | - Honghui He
- Department of Pediatric Retinal Surgery, Shenzhen Eye Hospital, 18 Zetian Road, Shenzhen, 518040, Guangdong, China
| | - Jian Zeng
- Department of Pediatric Retinal Surgery, Shenzhen Eye Hospital, 18 Zetian Road, Shenzhen, 518040, Guangdong, China
| | - Lei Zheng
- Department of Pediatric Retinal Surgery, Shenzhen Eye Hospital, 18 Zetian Road, Shenzhen, 518040, Guangdong, China
| | - Linlin Zhang
- Department of Child Health Care, Shenzhen Children's Hospital, 7019 Yitian Road, Shenzhen, 518040, Guangdong Province, China
| | - Victor S M C Correa
- Retina Service, Ines and Fred Yeatts Retina Research Laboratory, Angiogenesis Laboratory, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, 02114, USA
| | - Guishuang Ying
- Center for Preventative Ophthalmology and Biostatistics, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 700, Philadelphia, PA, 19104, USA
| | - Shaochong Zhang
- Department of Pediatric Retinal Surgery, Shenzhen Eye Hospital, 18 Zetian Road, Shenzhen, 518040, Guangdong, China
| | - Guoming Zhang
- Department of Pediatric Retinal Surgery, Shenzhen Eye Hospital, 18 Zetian Road, Shenzhen, 518040, Guangdong, China.
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Lee CC, Chiang MC, Chu SM, Wu WC, Ho MMC, Lien R. Clinical Risk Factors for Retinopathy of Prematurity Reactivation after Intravitreal Antivascular Endothelial Growth Factor Injection. J Pediatr 2024; 273:113913. [PMID: 38218371 DOI: 10.1016/j.jpeds.2024.113913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/15/2023] [Accepted: 01/09/2024] [Indexed: 01/15/2024]
Abstract
OBJECTIVE To assess the rate and risk factors for reactivation of retinopathy of prematurity (ROP) after intravitreal injection (IVI) of antivascular endothelial growth factor (VEGF) agents. STUDY DESIGN Infants who received IVI therapy between 2017 and 2022 were enrolled and divided into 2 groups: those with and without ROP reactivation. Information on ROP variables and patient variables were analyzed using multivariable logistic regression. RESULTS A total of 114 infants with 223 eyes were enrolled in the study. The ROP reactivation rate was 11.4% of infants (9.9% of eyes). The mean duration of reactivation was 84 ± 45 days. Among the 223 eyes treated with IVI, reactivation rates were 6% for bevacizumab, 13.9% for aflibercept, and 22.2% for ranibizumab. A multivariable regression model showed that ranibizumab was an independent risk factor (OR 11.4, P = .008) for reactivation. Other risk factors included infants with periventricular leukomalacia (OR 13.8, P = .003), patent ductus arteriosus ligation (OR 10.7, P = .032), and infants who still required invasive mechanical ventilation on the day of IVI therapy (OR 7.0, P = .018). CONCLUSIONS All anti-VEGF agents carry a risk of ROP reactivation, with the risk being greater with ranibizumab 0.25 mg than with bevacizumab 0.625 mg. Reactivation of ROP should be assessed vigilantly, especially in those infants with increased risks. Future research to determine the optimal anti-VEGF selection and dosage in high-risk infants is warranted.
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Affiliation(s)
- Chien-Chung Lee
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Ming-Chou Chiang
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Shih-Ming Chu
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Margaret Ming-Chih Ho
- Department of Ophthalmology, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Reyin Lien
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC.
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Tung HF, Chen YL, Chen YC, Chiu SL, Chen SN. Six years follow-up of type 1 retinopathy of prematurity (ROP) treated with intravitreal injection of ranibizumab and bevacizumab: Long-Term Outcomes of intravitreal injection in Type 1 ROP. Medicine (Baltimore) 2024; 103:e39251. [PMID: 39121269 PMCID: PMC11315552 DOI: 10.1097/md.0000000000039251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 07/19/2024] [Indexed: 08/11/2024] Open
Abstract
To investigate biometric and refractive results in patients with type 1 retinopathy of prematurity (ROP) treated by intravitreal injection (IVI) of ranibizumab (R) and bevacizumab (B) at the corrected age of 6. This is a single-center retrospective study. Infants diagnosed with type 1 ROP and treated with IVI of either R or B as the primary therapy were included. Data on axial length, anterior chamber depth (ACD), and lens thickness (LT) were obtained using A-scan ultrasound. Cycloplegic refraction, keratometry (K), and best-corrected visual acuity were also documented. Additionally, optical coherence tomography angiography was performed to assess the foveal avascular zone and the density of superficial and deep vessels. We analyzed the structural and functional differences between the 2 groups and compared them with findings from a previous study conducted when these children were between the ages of 1 and 3. The study included 60 eyes from 34 patients, with 34 eyes receiving B and 26 eyes receiving R injections for ROP. In biometric outcomes, there was still a deeper ACD (3.36 ± 0.24 mm in the B group; 3.52 ± 0.21 mm in the R group) and thinner LT (3.63 ± 0.16 mm in the B group; 3.53 ± 0.12 mm in the R group) in the R group, as previously reported at the age of 3. In the refractive aspect, the eyes treated with B had higher myopia at the ages of 1 and 3; however, at the age of 6, refractive errors did not differ significantly between the 2 groups. At the corrected age of 6, the eyes treated with IVI of R were associated with deeper ACD and thinner LT. Interestingly, the emmetropization process resulted in a similar incidence of high myopia at the age of 6, which was different from the outcomes observed at younger ages.
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Affiliation(s)
- Hsiao-Fan Tung
- Department of Ophthalmology, China Medical University Hospital, Taichung, Taiwan
| | - Yi-Ling Chen
- Department of Surgery, Clinical Research Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Yen-Chih Chen
- Department of Ophthalmology, Changhua Christian Hospital, Changhua, Taiwan
| | - Shin-Lin Chiu
- Department of Ophthalmology, Changhua Christian Hospital, Changhua, Taiwan
- Department of Nursing, College of Nursing and Health Sciences, Da-Yeh University, Changhua, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - San-Ni Chen
- Department of Ophthalmology, China Medical University Hospital, Taichung, Taiwan
- Department of Optometry, Da-Yeh University, Changhua, Taiwan
- Department of Medicine, School of Medicine, Chung-Shan Medical University, Taichung, Taiwan
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Morotti F, Aversa S, Barbieri F, Risso FM. Delayed episode of necrotising enterocolitis in an ex-preterm infant after intravitreal administration of low-dose ranibizumab for the treatment of retinopathy of prematurity. BMJ Case Rep 2024; 17:e259537. [PMID: 38839401 DOI: 10.1136/bcr-2023-259537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024] Open
Abstract
Retinopathy of prematurity (ROP) and necrotising enterocolitis (NEC) are complications of prematurity. Despite being quite different in terms of incidence, pathogenesis and consequences, both share a pathogenic role of aberrant vascularisation: increased in ROP, deficient for NEC. Current therapy for ROP includes the use of anti-vascular endothelial growth factor (anti-VEGF) agents, which are able to interrupt retinal hypervascularity. Despite being delivered intravitreously, anti-VEGF used in ROP can be absorbed into circulation and exert systemic effects. We present here a case of an ex-27 weeks gestational age infant, presenting multiple NEC risk factors, treated at 2 months of age with low-dose ranibizumab, who developed a large bowel NEC episode in the first week after treatment. We believe that this further report of an association between anti-VEGF agents and NEC could be interesting for the identification of children at risk of severe adverse events and stimulating further research on the topic.
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Affiliation(s)
- Francesco Morotti
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Salvatore Aversa
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Fabiana Barbieri
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Francesco Maria Risso
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
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Huang YC, Hsu KH, Chu SM, Chiang MC, Lien R, Chen KJ, Hwang YS, Lai CC, Tseng HJ, Wu WC. Respiratory outcomes in preterm infants following intravitreal bevacizumab for retinopathy of prematurity-a 10-year matched case study. Eye (Lond) 2023; 37:3675-3681. [PMID: 37400566 PMCID: PMC10686401 DOI: 10.1038/s41433-023-02579-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 04/05/2023] [Accepted: 05/11/2023] [Indexed: 07/05/2023] Open
Abstract
OBJECTIVES To evaluate respiratory outcomes in preterm infants with retinopathy of prematurity (ROP) following intravitreal bevacizumab injection (IVB). METHODS This single-centre study enroled preterm infants with a gestational age (GA) < 34 weeks or a birth weight (BW) < 1500 g with bilateral type 1 ROP who received a single IVB, and a treatment-free control group matched by GA, postmenstrual age, and respiratory status at the time of the IVB. The primary outcome was serial respiratory changes in mean airway pressure (MAP), fraction of inspired oxygen (FiO2), and respiratory severity score (RSS, MAP x FiO2) during the 28-day post-IVB/matching period and overall respiratory improvement at day 28 and at discharge. The duration of supplemental oxygen therapy following IVB/matching was documented. RESULTS A total of 5578 infants were included. Seventy-eight infants were enroled in the IVB group, and another 78 infants were matched as the control group. Both groups had downward trends in the MAP, FiO2, and RSS over the study period (all P < 0.001), but there were no between-group differences in these measures. The percentage of overall respiratory improvement was similar between the IVB and control groups, so was the duration of invasive and in-hospital oxygen ventilation. A lower percentage of oxygen dependence at discharge in the IVB group (P = 0.03) remained significant after adjusting for GA and BW. CONCLUSIONS This is a matched case study to evaluate respiratory outcomes in preterm infants following IVB for ROP. We found that the IVBs did not compromise respiratory outcomes in preterm infants during the 28-day post-IVB period and at discharge.
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Affiliation(s)
- Ying-Chen Huang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Kai-Hsiang Hsu
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Science, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Ming Chu
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Chou Chiang
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Science, Chang Gung University, Taoyuan, Taiwan
| | - Reyin Lien
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuan-Jen Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yih-Shiou Hwang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Chun Lai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Hsiao-Jung Tseng
- Biostatistics unit, Clinical Trial Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan.
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Woods J, Biswas S. Retinopathy of prematurity: from oxygen management to molecular manipulation. Mol Cell Pediatr 2023; 10:12. [PMID: 37712996 PMCID: PMC10504188 DOI: 10.1186/s40348-023-00163-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 08/11/2023] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION Retinopathy of prematurity (ROP) is a vasoproliferative disorder of the premature retina with the potential to progress to extraretinal neovascularisation. This review serves as an introduction to retinopathy of prematurity (ROP), outlining key parts of ROP pathophysiology, diagnosis and treatment. ROP is traditionally diagnosed by indirect ophthalmoscopy and classified using anatomical zones, stages of disease, and the presence or absence of "plus disease" (dilation and tortuosity of the major retinal arterioles and venules). ROP has a bi-phasic pathophysiology: initial hyperoxia causes reduced retinal vascularisation, followed by pathological vaso-proliferation resulting from subsequent hypoxia and driven by vascular endothelial growth factor (VEGF). ADVANCEMENTS IN MANAGEMENT This review summarises previous trials to establish optimum oxygen exposure levels in newborns and more recently the development of anti-VEGF agents locally delivered to block pathological neovascularisation, which is technically easier to administer and less destructive than laser treatment. FUTURE DIRECTIONS There remains an ongoing concern regarding the potential unwanted systemic effects of intravitreally administered anti-VEGF on the overall development of the premature baby. Ongoing dosing studies may lessen these fears by identifying the minimally effective dose required to block extraretinal neovascularisation.
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Affiliation(s)
- Jonathan Woods
- University of Birmingham Medical School, Medical School, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Susmito Biswas
- Manchester Royal Eye Hospital, Manchester University Hospital NHS Foundation Trust, Oxford Rd, Manchester, M13 9WL, UK
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Modrzejewska M, Nazwalska M. The Long-Term Observation of the Beneficial Effects of Treatment: 0.12 mg Anti-VEGF Monotherapy or Anti-VEGF Combined Therapy and Diode-Laser in Various Stages of Retinopathy of Prematurity-Series of Cases. J Clin Med 2023; 12:5644. [PMID: 37685711 PMCID: PMC10488330 DOI: 10.3390/jcm12175644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 06/20/2023] [Accepted: 07/11/2023] [Indexed: 09/10/2023] Open
Abstract
Background 2-year observations of ranibizumab monotherapy and combined therapy with diode laser for severe ROP in extremely prematures. Materials and methods: In a group of 18 prematures (n = 36 eyes; 5 study groups); 25.8 ± 1.5 Hbd, birth weight 796.5 ± 166.1 g. Apgar 4.62 ± 1.88) with A-ROP (n = 22; 61%) and 3 ROP (plus) (n = 14; 39%), ranibizumab monotherapy (n = 4 eyes) in dose 0.12 mg/0.12 mL or with diode laser (n = 32 eyes) were applied. The first intervention was carried out in PMA of 33 (gr. 4 and 5) and 34 in (gr. 1, 2, 3), mean follow-up time 21.44 ± 8.7 months. One-way analysis of variance (ANOVA) with Welch's correction, non-parametric Kruskal-Wallis test, Chi square test of independence were used. A retrospective observational study based on a case series. Results Retinal attachment was achieved in 92.3% of the studied eyes. Bilateral retinal detachment was noted in 1 infant (2 eyes). Myopization (-0.75 to -7.5 D) was observed in 5 infants (45%); mild hyperopia (+0.5 to +4.5 D) was observed in the rest infants (55%). Conclusions Individualization strategies in severe ROP with lower dose 0.12 mg Ranibizumab or combined laser-therapy resulted in effective outcomes. Myopia has not been reported in patients where Ranibizumab was the first drug administered in the ROP treatment strategy.
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Affiliation(s)
- Monika Modrzejewska
- Second Department of Ophthalmology, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland
| | - Martyna Nazwalska
- Department of Ophthalmology, Independent Public Health Care Center of the Ministry of the Interior and Administration (SP ZOZ MSWiA), ul. Jagiellońska 44, 70-382 Szczecin, Poland;
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Li JQ, Pfeil JM, Stahl A, Krohne TU. [Late sequelae of retinopathy of prematurity in infancy]. DIE OPHTHALMOLOGIE 2023; 120:588-596. [PMID: 37221277 DOI: 10.1007/s00347-023-01876-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Retinopathy of prematurity (ROP) is one of the most frequent causes of severe visual impairment or blindness in childhood and can lead to severe late complications in children even after the initial disease has resolved. PURPOSE The present study summarizes possible late effects in childhood after treated and untreated ROP. A special focus is on the development of myopia, retinal detachment, as well as neurological and pulmonary development after anti-vascular endothelial growth factor (VEGF) treatment. MATERIAL AND METHODS This work is based on a selective literature search on late effects in childhood of treated or untreated ROP. RESULTS Preterm infants have an increased risk of developing high-grade myopia. Interestingly, several studies indicate that the risk of myopia is reduced following anti-VEGF treatment. With anti-VEGF treatment, however, late recurrences after initial response are possible even after several months, making long-term and frequent follow-up examinations essential. Controversy exists regarding the possible negative effects of anti-VEGF treatment on neurological and pulmonary development. After both treated and untreated ROP, rhegmatogenous, tractional or exudative retinal detachment, vitreous hemorrhage, high myopia and strabismus are possible late complications. DISCUSSION Children with a history of ROP with or without treatment have an increased risk for late ocular sequelae, such as high myopia, retinal detachment, vitreous hemorrhage and strabismus. A seamless transition from ROP screening to pediatric and ophthalmological follow-up care is therefore essential for timely detection and treatment of possible refractive errors, strabismus, or other amblyogenic changes.
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Affiliation(s)
- Jeany Q Li
- Zentrum für Augenheilkunde, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - Johanna M Pfeil
- Klinik und Poliklinik für Augenheilkunde, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - Andreas Stahl
- Klinik und Poliklinik für Augenheilkunde, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - Tim U Krohne
- Zentrum für Augenheilkunde, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
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Cao JK, Han T, Tang HY, Zhang S, Wang ZH, Feng ZC, Li QP. Comparison of post-treatment recurrence between ranibizumab injection and laser photocoagulation for type 1 retinopathy of prematurity. BMC Ophthalmol 2023; 23:137. [PMID: 37016343 PMCID: PMC10071726 DOI: 10.1186/s12886-023-02886-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/26/2023] [Indexed: 04/06/2023] Open
Abstract
OBJECTIVE To compare post-treatment recurrence between ranibizumab injection and laser photocoagulation (LP) for type 1 retinopathy of prematurity (ROP), and explore the associated risk factors. METHODS The clinical data of ROP infants treated with LP or ranibizumab in a NICU of China from October 2007 to November 2021 were retrospectively analyzed and compared, such as general condition, degree of ROP, therapeutic effectiveness and post-treatment recurrence. The dependent variable was recurrence after ROP treatment. Univariate and regression analysis of risk factors was performed. RESULTS Of the 298 ROP infants (556 eyes), 58% of the eyes were treated with LP and the other 42% with ranibizumab. There was no significant difference in gestational age at birth, birth weight, sex, delivery mode, prenatal corticosteroids, ROP diagnosed before admission or after admission, and the duration of oxygen therapy between the two groups. However, the ratio of type 1 ROP and aggressive retinopathy of prematurity (A-ROP) in ranibizumab group was higher than that in LP group. The number of treatments, recurrence rate and recurrence interval in ranibizumab group were higher than those in LP group. However, there was no difference in the recurrence rate between the two groups after stratified analysis by the lesion area and the presence or absence of A-ROP. There was no significant difference in the final lesion regression between the two groups. Regression analysis showed that plus disease and ROP located in zone I were independent risk factors for post-treatment recurrence. CONCLUSION There is no significant difference in the recurrence rate of ROP between ranibizumab injection and LP, and recurrence is mainly related to the severity of ROP. In half of our patients treated with A-ROP recurrences occur.
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Affiliation(s)
- Jing-Ke Cao
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Tao Han
- Department of Neonatology, Senior Department of Pediatrics, The Seventh Medical Center of Chinese PLA General Hospital, NO.5 Nanmencang, Dongcheng District, Beijing, 100700, China
| | - Hong-Yi Tang
- The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, China
| | - Sheng Zhang
- Department of Neonatology, Senior Department of Pediatrics, The Seventh Medical Center of Chinese PLA General Hospital, NO.5 Nanmencang, Dongcheng District, Beijing, 100700, China
| | - Zong-Hua Wang
- Department of Ophthalmology, the Seventh Medical Center of Chinese PLA General Hospital, Beijing, 100700, China
| | - Zhi-Chun Feng
- Department of Neonatology, Senior Department of Pediatrics, The Seventh Medical Center of Chinese PLA General Hospital, NO.5 Nanmencang, Dongcheng District, Beijing, 100700, China
| | - Qiu-Ping Li
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China.
- Department of Neonatology, Senior Department of Pediatrics, The Seventh Medical Center of Chinese PLA General Hospital, NO.5 Nanmencang, Dongcheng District, Beijing, 100700, China.
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11
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Patel NA, Acaba-Berrocal LA, Hoyek S, Fan KC, Martinez-Castellanos MA, Baumal CR, Harper CA, Berrocal AM. Comparison in Retreatments between Bevacizumab and Ranibizumab Intravitreal Injections for Retinopathy of Prematurity: A Multicenter Study. Ophthalmology 2023; 130:373-378. [PMID: 36396121 DOI: 10.1016/j.ophtha.2022.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/01/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To compare the types and dosages of anti-vascular endothelial growth factors (VEGFs) to ascertain whether specific dosages or types of injection were associated with retreatment in clinical practice in the United States. DESIGN Multicenter, retrospective, consecutive series. PARTICIPANTS Patients with retinopathy of prematurity (ROP) treated with anti-VEGF injections from 2007 to 2021. METHODS Sixteen sites from the United States participated. Data collected included demographics, birth characteristics, examination findings, type and dose of anti-VEGF treatment, retreatment rates, and time to retreatment. Comparisons of retreatment rates between bevacizumab and ranibizumab intravitreal injections were made. MAIN OUTCOME MEASURES Relative rate of retreatment between varying types of anti-VEGF therapy, including bevacizumab and ranibizumab, and the various dosages used for each. RESULTS Data from 873 eyes of 661 patients (61% male and 39% female) were collected. After exclusion of 40 eyes treated with laser before anti-VEGF injection and 266 eyes re-treated with laser at or beyond 8 weeks after the initial anti-VEGF treatment, 567 eyes of 307 patients (63% male and 37% female) remained and were included in the primary analysis. There was no difference between the no retreatment and retreatment groups in terms of birthweight, gestational age, age at first injection, ROP stages, or number of involved clock hours. The retreatment group had a larger percentage of aggressive ROP (34% vs. 18%, P < 0.001) and greater percentage of zone 1 ROP (49 vs. 34%, P = 0.001) than the no retreatment group. Ranibizumab use was associated with a higher rate of retreatment than bevacizumab use (58% vs. 37%, P < 0.001), whereas the rate of retreatment was not associated with a specific dose of ranibizumab (R2 = 0.67, P = 0.32). Meanwhile, lower doses of bevacizumab were associated with higher rates of retreatment compared with the higher doses (R2 = 0.84, P = 0.01). There was a dose-specific trend with higher doses trending toward lower retreatments for bevacizumab. CONCLUSIONS In a multicenter study of ROP patients initially treated with anti-VEGF therapy, ranibizumab and lower-dose bevacizumab use were associated with an increased rate of retreatment when compared with higher-dose bevacizumab. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Nimesh A Patel
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; Bascom Palmer Eye Institute, University of Miami Leonard M. Miller School of Medicine, Miami, Florida; Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Luis A Acaba-Berrocal
- Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois
| | - Sandra Hoyek
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Kenneth C Fan
- Bascom Palmer Eye Institute, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - Maria Ana Martinez-Castellanos
- Association to Prevent Blindness, Hospital Luis Sanchez Bulnes, National Autonomous University of Mexico, Mexico City, Mexico
| | - Caroline R Baumal
- Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
| | - C Armitage Harper
- Department of Ophthalmology, Austin Retina Associates, Austin, Texas
| | - Audina M Berrocal
- Bascom Palmer Eye Institute, University of Miami Leonard M. Miller School of Medicine, Miami, Florida.
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12
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Raghuveer TS, Zackula RE, Okut H. Is Anti-Vascular Growth Factor Therapy for Retinopathy of Prematurity Associated With Pulmonary Hypertension? JAMA Ophthalmol 2023; 141:406-407. [PMID: 36862404 DOI: 10.1001/jamaophthalmol.2023.0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Affiliation(s)
- Talkad S Raghuveer
- Department of Pediatrics, University of Kansas Medical School-Wichita, Wichita.,University of Kansas School of Medicine-Wichita
| | - Rosey E Zackula
- University of Kansas School of Medicine-Wichita.,Research Department, University of Kansas Medical School-Wichita
| | - Hayrettin Okut
- University of Kansas School of Medicine-Wichita.,Research Department, University of Kansas Medical School-Wichita
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13
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Chiang MC, Chen YT, Kang EYC, Chen KJ, Wang NK, Liu L, Chen YP, Hwang YS, Lai CC, Wu WC. Neurodevelopmental Outcomes for Retinopathy of Prematurity: A Taiwan Premature Infant Follow-up Network Database Study. Am J Ophthalmol 2023; 247:170-180. [PMID: 36343698 DOI: 10.1016/j.ajo.2022.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/29/2022] [Accepted: 10/29/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE To evaluate the neurodevelopmental outcomes in premature infants who received intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections to treat retinopathy of prematurity (ROP). DESIGN Retrospective cohort study. METHODS This study was conducted using the database from the Taiwan Premature Infant Follow-up Network. Demographic data, systemic risk factors, ROP status, and neurodevelopmental assessment using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) were collected. Patients were divided into 4 groups: prematurity without ROP, ROP without treatment, ROP with laser treatment, and ROP with intravitreal anti-VEGF treatment. A generalized estimating equation was used for analyzing repeated measurements of Bayley-III at the corrected ages of 6, 12, and 24 months. RESULTS A total of 2090 patients with a mean gestational age of 31.2 weeks were included. The Bayley-III composite scores of patients with ROP treated with anti-VEGF were comparable to those of patients with ROP without treatment (cognitive: P = .491; language: P = .201; motor: P = .151) and premature patients without ROP (cognitive: P = .985; language: P = .452; motor: P = .169) after adjusting for confounders. Patients with ROP treated with laser photocoagulation exhibited poorer cognitive composite scores than did those without treatment (P < .001), premature patients without ROP (P < .001), and those treated with anti-VEGF (P < .001), but they had similar language and motor composite scores. CONCLUSIONS Intravitreal anti-VEGF treatment for ROP was not associated with adverse neurodevelopment in premature infants. Further studies are needed to determine whether general anesthesia or sedation used in laser treatment for ROP has significant impacts on neurodevelopmental outcomes.
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Affiliation(s)
- Ming-Chou Chiang
- Division of Neonatology, Department of Pediatrics (M.-C.C), Chang Gung Memorial Hospital, Linkou, Taiwan; Taiwan Premature Infant Follow-up Network (M.-C.C); College of Medicine (M.-C.C., Y.-T.C., E.Y.-K, K.-J.C., N.-K.W, L.L., Y.-P.C., Y.-S.H., C.-C.L., W.-C.W.), Chang Gung University, Taoyuan, Taiwan
| | - Yen-Ting Chen
- College of Medicine (M.-C.C., Y.-T.C., E.Y.-K, K.-J.C., N.-K.W, L.L., Y.-P.C., Y.-S.H., C.-C.L., W.-C.W.), Chang Gung University, Taoyuan, Taiwan; Department of Ophthalmology, Taiwan Premature Infant Follow-up Network (Y.-T.C., E.Y.-K, K.-J.C., N.-K.W, L.L., Y.-P.C., Y.-S.H.,, C.-C.L., W.-C.W.), Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Ophthalmology (Y.-T.C., Y.-P.C.), New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan
| | - Eugene Yu-Chuan Kang
- College of Medicine (M.-C.C., Y.-T.C., E.Y.-K, K.-J.C., N.-K.W, L.L., Y.-P.C., Y.-S.H., C.-C.L., W.-C.W.), Chang Gung University, Taoyuan, Taiwan; Department of Ophthalmology, Taiwan Premature Infant Follow-up Network (Y.-T.C., E.Y.-K, K.-J.C., N.-K.W, L.L., Y.-P.C., Y.-S.H.,, C.-C.L., W.-C.W.), Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Kuan-Jen Chen
- College of Medicine (M.-C.C., Y.-T.C., E.Y.-K, K.-J.C., N.-K.W, L.L., Y.-P.C., Y.-S.H., C.-C.L., W.-C.W.), Chang Gung University, Taoyuan, Taiwan; Department of Ophthalmology, Taiwan Premature Infant Follow-up Network (Y.-T.C., E.Y.-K, K.-J.C., N.-K.W, L.L., Y.-P.C., Y.-S.H.,, C.-C.L., W.-C.W.), Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Nan-Kai Wang
- College of Medicine (M.-C.C., Y.-T.C., E.Y.-K, K.-J.C., N.-K.W, L.L., Y.-P.C., Y.-S.H., C.-C.L., W.-C.W.), Chang Gung University, Taoyuan, Taiwan; Department of Ophthalmology, Taiwan Premature Infant Follow-up Network (Y.-T.C., E.Y.-K, K.-J.C., N.-K.W, L.L., Y.-P.C., Y.-S.H.,, C.-C.L., W.-C.W.), Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Laura Liu
- College of Medicine (M.-C.C., Y.-T.C., E.Y.-K, K.-J.C., N.-K.W, L.L., Y.-P.C., Y.-S.H., C.-C.L., W.-C.W.), Chang Gung University, Taoyuan, Taiwan; Department of Ophthalmology, Taiwan Premature Infant Follow-up Network (Y.-T.C., E.Y.-K, K.-J.C., N.-K.W, L.L., Y.-P.C., Y.-S.H.,, C.-C.L., W.-C.W.), Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yen-Po Chen
- College of Medicine (M.-C.C., Y.-T.C., E.Y.-K, K.-J.C., N.-K.W, L.L., Y.-P.C., Y.-S.H., C.-C.L., W.-C.W.), Chang Gung University, Taoyuan, Taiwan; Department of Ophthalmology, Taiwan Premature Infant Follow-up Network (Y.-T.C., E.Y.-K, K.-J.C., N.-K.W, L.L., Y.-P.C., Y.-S.H.,, C.-C.L., W.-C.W.), Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Ophthalmology (Y.-T.C., Y.-P.C.), New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan
| | - Yih-Shiou Hwang
- College of Medicine (M.-C.C., Y.-T.C., E.Y.-K, K.-J.C., N.-K.W, L.L., Y.-P.C., Y.-S.H., C.-C.L., W.-C.W.), Chang Gung University, Taoyuan, Taiwan; Department of Ophthalmology, Taiwan Premature Infant Follow-up Network (Y.-T.C., E.Y.-K, K.-J.C., N.-K.W, L.L., Y.-P.C., Y.-S.H.,, C.-C.L., W.-C.W.), Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chi-Chun Lai
- College of Medicine (M.-C.C., Y.-T.C., E.Y.-K, K.-J.C., N.-K.W, L.L., Y.-P.C., Y.-S.H., C.-C.L., W.-C.W.), Chang Gung University, Taoyuan, Taiwan; Department of Ophthalmology, Taiwan Premature Infant Follow-up Network (Y.-T.C., E.Y.-K, K.-J.C., N.-K.W, L.L., Y.-P.C., Y.-S.H.,, C.-C.L., W.-C.W.), Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Ophthalmology (C.-C.L.), Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Wei-Chi Wu
- College of Medicine (M.-C.C., Y.-T.C., E.Y.-K, K.-J.C., N.-K.W, L.L., Y.-P.C., Y.-S.H., C.-C.L., W.-C.W.), Chang Gung University, Taoyuan, Taiwan; Department of Ophthalmology, Taiwan Premature Infant Follow-up Network (Y.-T.C., E.Y.-K, K.-J.C., N.-K.W, L.L., Y.-P.C., Y.-S.H.,, C.-C.L., W.-C.W.), Chang Gung Memorial Hospital, Linkou, Taiwan.
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14
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Fevereiro-Martins M, Marques-Neves C, Guimarães H, Bicho M. Retinopathy of prematurity: A review of pathophysiology and signaling pathways. Surv Ophthalmol 2023; 68:175-210. [PMID: 36427559 DOI: 10.1016/j.survophthal.2022.11.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 11/15/2022] [Accepted: 11/18/2022] [Indexed: 11/25/2022]
Abstract
Retinopathy of prematurity (ROP) is a vasoproliferative disorder of the retina and a leading cause of visual impairment and childhood blindness worldwide. The disease is characterized by an early stage of retinal microvascular degeneration, followed by neovascularization that can lead to subsequent retinal detachment and permanent visual loss. Several factors play a key role during the different pathological stages of the disease. Oxidative and nitrosative stress and inflammatory processes are important contributors to the early stage of ROP. Nitric oxide synthase and arginase play important roles in ischemia/reperfusion-induced neurovascular degeneration. Destructive neovascularization is driven by mediators of the hypoxia-inducible factor pathway, such as vascular endothelial growth factor and metabolic factors (succinate). The extracellular matrix is involved in hypoxia-induced retinal neovascularization. Vasorepulsive molecules (semaphorin 3A) intervene preventing the revascularization of the avascular zone. This review focuses on current concepts about signaling pathways and their mediators, involved in the pathogenesis of ROP, highlighting new potentially preventive and therapeutic modalities. A better understanding of the intricate molecular mechanisms underlying the pathogenesis of ROP should allow the development of more effective and targeted therapeutic agents to reduce aberrant vasoproliferation and facilitate physiological retinal vascular development.
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Affiliation(s)
- Mariza Fevereiro-Martins
- Laboratório de Genética and Grupo Ecogenética e Saúde Humana, Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Portugal; Instituto de Investigação Científica Bento da Rocha Cabral, Lisboa, Portugal; Departamento de Oftalmologia, Hospital Cuf Descobertas, Lisboa, Portugal.
| | - Carlos Marques-Neves
- Centro de Estudos das Ci.¼ncias da Visão, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal; Grupo Ecogenética e Saúde Humana, Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
| | - Hercília Guimarães
- Departamento de Ginecologia-Obstetrícia e Pediatria, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.
| | - Manuel Bicho
- Laboratório de Genética and Grupo Ecogenética e Saúde Humana, Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Portugal; Instituto de Investigação Científica Bento da Rocha Cabral, Lisboa, Portugal.
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15
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Systemic Cytokines in Retinopathy of Prematurity. J Pers Med 2023; 13:jpm13020291. [PMID: 36836525 PMCID: PMC9966226 DOI: 10.3390/jpm13020291] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 01/30/2023] [Accepted: 01/30/2023] [Indexed: 02/09/2023] Open
Abstract
Retinopathy of prematurity (ROP), a vasoproliferative vitreoretinal disorder, is the leading cause of childhood blindness worldwide. Although angiogenic pathways have been the main focus, cytokine-mediated inflammation is also involved in ROP etiology. Herein, we illustrate the characteristics and actions of all cytokines involved in ROP pathogenesis. The two-phase (vaso-obliteration followed by vasoproliferation) theory outlines the evaluation of cytokines in a time-dependent manner. Levels of cytokines may even differ between the blood and the vitreous. Data from animal models of oxygen-induced retinopathy are also valuable. Although conventional cryotherapy and laser photocoagulation are well established and anti-vascular endothelial growth factor agents are available, less destructive novel therapeutics that can precisely target the signaling pathways are required. Linking the cytokines involved in ROP to other maternal and neonatal diseases and conditions provides insights into the management of ROP. Suppressing disordered retinal angiogenesis via the modulation of hypoxia-inducible factor, supplementation of insulin-like growth factor (IGF)-1/IGF-binding protein 3 complex, erythropoietin, and its derivatives, polyunsaturated fatty acids, and inhibition of secretogranin III have attracted the attention of researchers. Recently, gut microbiota modulation, non-coding RNAs, and gene therapies have shown promise in regulating ROP. These emerging therapeutics can be used to treat preterm infants with ROP.
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16
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Diggikar S, Gurumoorthy P, Trif P, Mudura D, Nagesh NK, Galis R, Vinekar A, Kramer BW. Retinopathy of prematurity and neurodevelopmental outcomes in preterm infants: A systematic review and meta-analysis. Front Pediatr 2023; 11:1055813. [PMID: 37009271 PMCID: PMC10050340 DOI: 10.3389/fped.2023.1055813] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/16/2023] [Indexed: 04/04/2023] Open
Abstract
Background Retinopathy of prematurity (ROP) and abnormal brain development share similar risk factors and mechanisms. There has been contrasting evidence on the association of ROP with adverse neurodevelopmental outcomes. Objective We analysed the association between ROP at levels of severity and treatment with all neurodevelopmental outcomes until adolescence. Data source We followed PRISMA guidelines and searched Medline and Embase between 1 August 1990 and 31 March 2022. Study selection and participants Randomised or quasi-randomised clinical trials and observational studies on preterm infants (<37 weeks) with ROP [type 1 or severe ROP, type 2 or milder ROP, laser or anti-vascular endothelial growth factor (VEGF) treated] were included. Data extraction and synthesis We included studies on ROP and any neurocognitive or neuropsychiatric outcomes. Outcomes The primary outcomes were as follows: cognitive composite scores evaluated between the ages of 18 and 48 months by the Bayley Scales of Infant and Toddler Development (BSID) or equivalent; neurodevelopmental impairment (NDI; moderate to severe NDI or severe NDI), cerebral palsy, cognitive impairment; and neuropsychiatric or behavioural problems. The secondary outcomes were as follows: motor and language composite scores evaluated between the ages of 18 and 48 months by BSID or equivalent; motor/language impairment; and moderate/severe NDI as defined by the authors. Results In preterm infants, "any ROP" was associated with an increased risk of cognitive impairment or intellectual disability [n = 83,506; odds ratio (OR): 2.56; 95% CI: 1.40-4.69; p = 0.002], cerebral palsy (n = 3,706; OR: 2.26; 95% CI: 1.72-2.96; p < 0.001), behavioural problems (n = 81,439; OR: 2.45; 95% CI: 1.03-5.83; p = 0.04), or NDI as defined by authors (n = 1,930; OR: 3.83; 95% CI: 1.61-9.12; p = 0.002). Type 1 or severe ROP increased the risk of cerebral palsy (OR: 2.19; 95% CI: 1.23-3.88; p = 0.07), cognitive impairment or intellectual disability (n = 5,167; OR: 3.56; 95% CI: 2.6-4.86; p < 0.001), and behavioural problems (n = 5,500; OR: 2.76; 95% CI: 2.11-3.60; p < 0.001) more than type 2 ROP at 18-24 months. Infants treated with anti-VEGF had higher odds of moderate cognitive impairment than the laser surgery group if adjusted data (gestational age, sex severe intraventricular haemorrhage, bronchopulmonary dysplasia, sepsis, surgical necrotising enterocolitis, and maternal education) were analysed [adjusted OR (aOR): 1.93; 95% CI: 1.23-3.03; p = 0.04], but not for cerebral palsy (aOR: 1.29; 95% CI: 0.65-2.56; p = 0.45). All outcomes were adjudged with a "very low" certainty of evidence. Conclusion and relevance Infants with "any ROP" had higher risks of cognitive impairment or intellectual disability, cerebral palsy, and behavioural problems. Anti-VEGF treatment increased the risk of moderate cognitive impairment. These results support the association of ROP and anti-VEGF treatment with adverse neurodevelopmental outcomes. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier: CRD42022326009.
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Affiliation(s)
- Shivashankar Diggikar
- Department of Paediatrics, Oyster Woman and Child Hospital, Bengaluru, India
- Correspondence: Shivashankar Diggikar
| | - Puvaneswari Gurumoorthy
- Centre for Cellular and Molecular Platforms, National Centre for Biological Sciences, Bengaluru, India
| | - Paula Trif
- Department of Neonatology, Emergency County Hospital of Bihor, Oradea, Romania
- Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
| | - Diana Mudura
- Department of Neonatology, Emergency County Hospital of Bihor, Oradea, Romania
| | | | - Radu Galis
- Department of Paediatric Retina, Narayana Nethralaya Eye Institute, Bengaluru, India
| | - Anand Vinekar
- Department of Paediatric Retina, Narayana Nethralaya Eye Institute, Bengaluru, India
| | - Boris W. Kramer
- Department of Paediatrics, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands
- School of Women’s and Infants’ Health, University of Western Australia, Crawley, WA, Australia
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17
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Huang CY, Huang HC, Chen MH, Lai TT, Chou HC, Chen CY, Yen TA, Cardoso WV, Tsao PN. Intravitreal Bevacizumab Is Associated With Prolonged Ventilatory Support in Preterm Infants With Bronchopulmonary Dysplasia. Chest 2022; 162:1328-1337. [PMID: 35753385 DOI: 10.1016/j.chest.2022.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 05/31/2022] [Accepted: 06/15/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Intravitreal bevacizumab (IVB), an anti-vascular endothelial growth factor (VEGF) antibody, is a widely adopted treatment for retinopathy of prematurity (ROP). Although animal studies have demonstrated that IVB inhibits alveologenesis in neonatal rat lung, the clinical influence of IVB on respiratory outcomes has not been studied. RESEARCH QUESTION Does IVB affect the respiratory outcome in preterm infants with bronchopulmonary dysplasia? STUDY DESIGN AND METHODS We retrospectively assessed very low birth weight (VLBW) preterm infants admitted to our neonatal ICU between January 2016 and June 2021. Furthermore, we evaluated the short-term respiratory outcomes after IVB therapy in VLBW preterm infants requiring ventilatory support at 36 weeks' postmenstrual age (PMA). RESULTS One hundred seventy-four VLBW preterm infants with bronchopulmonary dysplasia were recruited. Eighty-eight infants showed ROP onset before being ventilator free, and 78 infants received a diagnosis of the most severe ROP before being ventilator free. Among them, 32 received a diagnosis with type 1 ROP and received IVB treatment. After adjusting for gestational age, birth body weight, and baseline respiratory status, we discovered that IVB is associated significantly with prolonged ventilatory support and a lower likelihood of becoming ventilator free (hazard ratio, 0.53; P = .03). INTERPRETATION IVB may have a short-term respiratory adverse effect in patients requiring ventilatory support at 36 weeks' PMA. Therefore, long-term follow-up for respiratory outcomes may be considered in VLBW infants who receive IVB treatment.
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Affiliation(s)
- Cho-Yi Huang
- Department of Pediatrics, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Hsin-Chung Huang
- Department of Pediatrics, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Mei-Huei Chen
- Department of Pediatrics, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan; Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Tso-Ting Lai
- Department of Ophthalmology, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Hung-Chieh Chou
- Department of Pediatrics, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Chien-Yi Chen
- Department of Pediatrics, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Ting-An Yen
- Department of Pediatrics, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Wellington V Cardoso
- Columbia Center for Human Development, Department of Medicine, Columbia University Medical Center, New York, NY
| | - Po-Nien Tsao
- Department of Pediatrics, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan; Research Center for Developmental Biology and Regenerative Medicine, National Taiwan University, Taipei, Taiwan.
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Tawfik GM, Shahein EA, Dabour SA, Hassanein D, Elshewy AM. Comparison of intravitreal injection of ranibizumab versus bevacizumab for treatment of type 1 and aggressive retinopathy of prematurity in rural Egypt. A randomized clinical trial. BMJ Open Ophthalmol 2022. [DOI: 10.1136/bmjophth-2022-001173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
ObjectiveThe objective of this study is to evaluate the efficacy of intravitreal ranibizumab (IVR) monotherapy compared with intravitreal bevacizumab (IVB) monotherapy for treatment of type 1 and aggressive retinopathy of prematurity (ROP) in rural Egypt.Methods36 eyes of 18 infants with bilateral aggressive or type 1 ROP were recruited between September 2020 and September 2022. Mean follow-up duration was 16.53 months. IVB was injected in the right eye and IVR in the left eye, rescue injection of the same initial anti-vascular endothelial growth factor (VEGF) in case of ROP reactivation. Outcome measures included regression achieved either by single injection or multiple injections or additional laser therapy at 55 weeks’ postmenstrual age (PMA), recurrence of ROP, total retinal vascularisation time and complications.ResultsInitial regression of ROP within 1 week occurred in 11/18 eyes (61.1%) in bevacizumab group and 15/18 eyes (83.3%) in ranibizumab group (p=0.137). Primary outcome measure was achieved in 14/18 eyes (77.8%) and 16/18 eyes (88.9%) in bevacizumab and ranibizumab groups, respectively (p=0.658). Late reactivation requiring retreatment with anti-VEGF was encountered in 4/18 eyes (22.2%) and 1/18 eyes (5.6%) in bevacizumab and ranibizumab groups, respectively (p=0.338). Peripheral laser therapy on the avascular retina was done in 3/18 eyes (16.7%) in each group at mean of 55.67 weeks' PMA.ConclusionBevacizumab and ranibizumab proved to be effective regarding regression of acute ROP and continuing peripheral retinal vascularisation. Higher proportion of reactivation with bevacizumab, however, clinically non-significant. Laser therapy can be postponed to reduce its complications.Trial registration numberNCT05033106.
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Zhang H, Yang X, Zheng F, Yin X, Wan S. Treatment for Nontype 1 Retinopathy of Prematurity by Intravitreal Injection of Antivascular Endothelial Growth Factor Drugs. J Ophthalmol 2022; 2022:6266528. [PMID: 36452412 PMCID: PMC9705111 DOI: 10.1155/2022/6266528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 11/03/2022] [Accepted: 11/08/2022] [Indexed: 09/10/2024] Open
Abstract
Background To explore clinical characteristics and treatment reasons for intravitreal injection of antivascular endothelial growth factor (anti-VEGF) drugs in the treatment of nontype 1 retinopathy of prematurity (ROP). Methods A retrospective study was conducted to screen the nontype 1 ROP from the collected ROP patients who received intravitreal injections of anti-VEGF drugs in Henan Eye Hospital from September 2018 to June 2021. Results A total of 138 ROP cases (262 eyes) were included in this study, including 39 cases (28.3%), 65 eyes (24.8%) that were the nontype 1 ROP. Compared with the type 1 ROP group, the nontype 1 ROP group had slightly later treatment time (39.8 ± 2.7 weeks vs 38.1 ± 2.6 weeks, P < 0.05) and a higher proportion of fusion protein drugs (87.2% vs 54.5%, P < 0.05). After intravitreal injection of anti-VEGF drugs, 27 eyes (41.5%) were cured and 38 eyes (58.5%) improved in the nontype 1 ROP group, without recurrence and aggravation cases. There were more lesions in zone II (63 eyes, 96.9%), with stage 2 (40 eyes, 61.5%) and stage 3 (23 eyes, 35.4%), and 58 eyes (89.2%) showed preplus in the nontype 1 ROP group. Treatment reasons included preplus in 58 eyes (89.2%), ridge aggravation in 22 eyes (33.8%), simultaneous treatment of the contralateral eye in 9 eyes (13.8%), no regression of lesions in the persistent stage 2 or 3 over PMA 44 weeks of follow-up in 8 eyes (12.3%), and logistical considerations in 4 eyes (6.2%). Conclusions Considering some peculiar clinical characteristics, treatment by intravitreal injection of anti-VEGF drugs may be considered carefully for some nontype 1 ROP in critical conditions.
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Affiliation(s)
- Haitao Zhang
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Zhengzhou 450003, China
| | - Xin Yang
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Zhengzhou 450003, China
| | - Fangfang Zheng
- Neonatal Intensive Care Unit of Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou 450003, China
| | - Xiangke Yin
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Zhengzhou 450003, China
| | - Suhua Wan
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Zhengzhou 450003, China
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20
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Huang CY, Lai SH, Tseng HJ, Yao TC, Wu WC. Pulmonary function in school-age children following intravitreal injection of bevacizumab for retinopathy of prematurity. Sci Rep 2022; 12:18788. [PMID: 36335152 PMCID: PMC9637204 DOI: 10.1038/s41598-022-22338-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
Abstract
The effect of anti-vascular endothelial growth factor on neonatal lung development was inconclusive. To evaluate pulmonary function in school-age children who have received intravitreal bevacizumab (IVB) for retinopathy of prematurity (ROP), this study included 118 school-aged children who were grouped into three groups: full-term control children (group 1), preterm children who had not received IVB treatment (group 2) and preterm children with ROP who had received IVB treatment (group 3). Pulmonary function was measured by spirometry and impulse oscillometry. Pulmonary function was significantly better in group 1 than in groups 2 and 3 (all p < 0.05 in forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), forced expiratory flow between 25 and 75% of FVC (FEF25-75), and respiratory resistance at 5 Hz and difference between respiratory resistance at 5 and 20 Hz (R5-R20). There were no statistically significant differences between group 2 and group 3 in all pulmonary function parameters, including FVC, FEV1, ratio of FEV1 to FVC, FEF25-75, R5, R20, R5-R20, and respiratory reactance at 5 Hz. In conclusion, our study revealed that preterm infants receiving IVB for ROP had comparable pulmonary function at school age to their preterm peers who had not received IVB treatment.
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Affiliation(s)
- Ching-Yen Huang
- grid.413801.f0000 0001 0711 0593Department of Ophthalmology, Chang Gung Memorial Hospital, 5 Fu-Hsin Street, Kweishan, Taoyuan, 33305 Taiwan
| | - Shen-Hao Lai
- grid.145695.a0000 0004 1798 0922College of Medicine, Chang Gung University, Taoyuan, Taiwan ,grid.413801.f0000 0001 0711 0593Division of Pulmonology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsiao-Jung Tseng
- grid.413801.f0000 0001 0711 0593Clinical Trial Center, Biostatistics Unit, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tsung-Chieh Yao
- grid.145695.a0000 0004 1798 0922College of Medicine, Chang Gung University, Taoyuan, Taiwan ,grid.413801.f0000 0001 0711 0593Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, 5 Fu-Hsin Street, Gueishan, Taoyuan, 33305 Taiwan
| | - Wei-Chi Wu
- grid.413801.f0000 0001 0711 0593Department of Ophthalmology, Chang Gung Memorial Hospital, 5 Fu-Hsin Street, Kweishan, Taoyuan, 33305 Taiwan ,grid.145695.a0000 0004 1798 0922College of Medicine, Chang Gung University, Taoyuan, Taiwan
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21
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Nitkin CR, Bamat NA, Lagatta J, DeMauro SB, Lee HC, Patel RM, King B, Slaughter JL, Campbell JP, Richardson T, Lewis T. Pulmonary Hypertension in Preterm Infants Treated With Laser vs Anti-Vascular Endothelial Growth Factor Therapy for Retinopathy of Prematurity. JAMA Ophthalmol 2022; 140:1085-1094. [PMID: 36201183 PMCID: PMC9539731 DOI: 10.1001/jamaophthalmol.2022.3788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/04/2022] [Indexed: 12/15/2022]
Abstract
Importance Anti-vascular endothelial growth factor (VEGF) therapy for retinopathy of prematurity (ROP) has potential ocular and systemic advantages compared with laser, but we believe the systemic risks of anti-VEGF therapy in preterm infants are poorly quantified. Objective To determine whether there was an association with increased risk of pulmonary hypertension (PH) in preterm infants with ROP following treatment with anti-VEGF therapy as compared with laser treatment. Design, Setting, and Participants This multicenter retrospective cohort study took place at neonatal intensive care units of 48 children's hospitals in the US in the Pediatric Health Information System database from 2010 to 2020. Participants included preterm infants with gestational age at birth 22 0/7 to 31 6/7 weeks who had ROP treated with anti-VEGF therapy or laser photocoagulation. Exposures Anti-VEGF therapy vs laser photocoagulation. Main Outcomes and Measures New receipt of pulmonary vasodilators at least 7 days after ROP therapy was compared between exposure groups, matched using propensity scores generated from preexposure variables, and adjusted for birth year and hospital. The odds of receiving an echocardiogram after 30 days of age was also included to adjust for secular trends and interhospital variation in PH screening. Results Among 1577 patients (55.9% male) meeting inclusion criteria, 689 received laser photocoagulation and 888 received anti-VEGF treatment (95% bevacizumab, 5% ranibizumab). Patients were first treated for ROP at median 36.4 weeks' postmenstrual age (IQR, 34.6-38.7). A total of 982 patients (491 in each group) were propensity score matched. Good covariate balance was achieved, as indicated by a model variance ratio of 1.15. More infants who received anti-VEGF therapy were treated for PH, but when adjusted for hospital and year, this was no longer statistically significant (6.7%; 95% CI, 2.6-6.9 vs 4.3% 95% CI, 4.4-10.2; adjusted odds ratio, 1.62; 95% CI, 0.90-2.89; P = .10). Conclusions and Relevance Anti-VEGF therapy was not associated with greater use of pulmonary vasodilators after adjustment for hospital and year. Our findings suggest exposure to anti-VEGF may be associated with PH, although we cannot exclude the possibility of residual confounding based on systemic comorbidities or hospital variation in practice. Future studies investigating this possible adverse effect seem warranted.
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Affiliation(s)
- Christopher R. Nitkin
- Children’s Mercy Kansas City, Division of Neonatology, Department of Pediatrics, University of Missouri Kansas City School of Medicine, Kansas City
| | - Nicolas A. Bamat
- Children’s Hospital of Philadelphia, Division of Neonatology, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Joanne Lagatta
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee
| | - Sara B. DeMauro
- Children’s Hospital of Philadelphia, Division of Neonatology, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Henry C. Lee
- Division of Neonatology, Department of Pediatrics, Stanford University, Stanford, California
| | - Ravi Mangal Patel
- Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Brian King
- Division of Neonatology, Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jonathan L. Slaughter
- Nationwide Children’s Hospital Center for Perinatal Research and The Ohio State University, Department of Pediatrics, College of Medicine and Division of Epidemiology, College of Public Health, Columbus
| | | | | | - Tamorah Lewis
- Children’s Mercy Kansas City, Division of Neonatology, Department of Pediatrics, University of Missouri Kansas City School of Medicine, Kansas City
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Bassiouny RM, Gaafar WM, El Nokrashy A, Abdelhameed AG, Attallah EA, Elgharieb AG, Bassiouny MR. Clinical outcome following reinjection of Ranibizumab for reactivation of retinopathy of prematurity. Eye (Lond) 2022; 36:2137-2143. [PMID: 34711941 PMCID: PMC9581953 DOI: 10.1038/s41433-021-01814-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 09/17/2021] [Accepted: 10/05/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND To assess reactivation after initial intravitreal injection of ranibizumab (IVR) for type 1 retinopathy of prematurity (ROP) or worse and the outcome following reinjection of ranibizumab for this reactivation. METHODS This retrospective study was performed on infants screened for ROP between March 2013 and February 2020 in Mansoura University Children Hospital, Mansoura, Egypt. Infants treated with ranibizumab 0.25 mg/0.025 mL were identified for review of their clinical outcomes. Data of infants with reactivation and IVR re-injection were analysed. RESULTS A total of 2318 infants were screened for ROP, 115 (5%) infants (216 eyes) with a mean gestational age of 30 ± 2.5 weeks and mean birth weight of 1290 ± 355.2 g received IVR at mean postmenstrual age (PMA) of 38 ± 3.1 weeks. All treated eyes demonstrated initial regression of ROP. However, ROP reactivation occurred in 5 (2.3%) eyes of 3 patients, at an average of 9.6 ± 2.9 weeks after treatment. None of these eyes had retinal detachment. A second dose IVR was administered and all five eyes showed regression with complete retinal vascularisation, at a mean PMA of 60 ± 5.1 weeks. CONCLUSIONS IVR is beneficial as an initial and subsequent treatment for type 1 ROP or APROP. A long-term follow-up until complete retinal vascularisation is recommended to avoid disease reactivation.
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Affiliation(s)
- Rania M Bassiouny
- Lecturer of Ophthalmology, Department of Ophthalmology, Mansoura Ophthalmic Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
| | - Walid M Gaafar
- Associate Professor of Ophthalmology, Department of Ophthalmology, Mansoura Ophthalmic Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Amgad El Nokrashy
- Lecturer of Ophthalmology, Department of Ophthalmology, Mansoura Ophthalmic Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ameera G Abdelhameed
- Associate Professor of Ophthalmology, Department of Ophthalmology, Mansoura Ophthalmic Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Eman A Attallah
- Assistant Lecturer of Ophthalmology, Department of Ophthalmology, Mansoura Ophthalmic Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed G Elgharieb
- Assistant Lecturer of Ophthalmology, Department of Ophthalmology, Mansoura Ophthalmic Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed R Bassiouny
- Professor of Pediatrics, Department of Pediatrics, Mansoura University Children Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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23
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Huang K, Lin Z, Ge Y, Chen X, Pan Y, Lv Z, Sun X, Yu H, Chen J, Yao Q. Immunomodulation of MiRNA-223-based nanoplatform for targeted therapy in retinopathy of prematurity. J Control Release 2022; 350:789-802. [PMID: 35961472 DOI: 10.1016/j.jconrel.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 07/08/2022] [Accepted: 08/04/2022] [Indexed: 11/19/2022]
Abstract
Retinopathy of prematurity (ROP) is characterized by pathological angiogenesis and associated inflammation in the retina and is the leading cause of childhood blindness. MiRNA-223 (miR-223) drives microglial polarization toward the anti-inflammatory phenotype and offers a therapeutic approach to suppress inflammation and consequently pathological neovascularization. However, miRNA-based therapy is hindered by the low stability and non-specific cell-targeting ability of delivery systems. In the present study, we developed folic acid-chitosan (FA-CS)-modified mesoporous silica nanoparticles (PMSN) loaded with miR-223 to regulate retinal microglial polarization. The FA-CS/PMSN/miR-223 nanoparticles exhibited high stability and loading efficiency, achieved targeted delivery, and successfully escaped from lysosomes. In cultured microglial cells, treatment with FA-CS/PMSN/miR-223 nanoparticles upregulated the anti-inflammatory gene YM1/2 and IL-4RA, and downregulated the proinflammatory genes iNOS, IL-1β, and IL-6. Notably, in a mouse oxygen-induced retinopathy model of ROP, intravitreally injected FA-CS/PMSN/miR-223 nanoparticles (1 μg) decreased the retinal neovascular area by 52.6%. This protective effect was associated with the reduced and increased levels of pro-inflammatory (M1) and anti-inflammatory (M2) cytokines, respectively. Collectively, these findings demonstrate that FA-CS/PMSN/miR-223 nanoparticles provide an effective therapeutic strategy for the treatment of ROP by modulating the miR-223-mediated microglial polarization to the M2 phenotype.
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Affiliation(s)
- Keke Huang
- Institute of Advanced Materials for Nano-Bio Applications, School of Ophthalmology & Optometry, Eye Hospital, Wenzhou Medical University, 270 Xueyuan Xi Road, Wenzhou, Zhejiang 325027, PR China
| | - Zhiqing Lin
- Institute of Advanced Materials for Nano-Bio Applications, School of Ophthalmology & Optometry, Eye Hospital, Wenzhou Medical University, 270 Xueyuan Xi Road, Wenzhou, Zhejiang 325027, PR China
| | - Yuanyuan Ge
- Institute of Advanced Materials for Nano-Bio Applications, School of Ophthalmology & Optometry, Eye Hospital, Wenzhou Medical University, 270 Xueyuan Xi Road, Wenzhou, Zhejiang 325027, PR China
| | - Xuhao Chen
- Institute of Advanced Materials for Nano-Bio Applications, School of Ophthalmology & Optometry, Eye Hospital, Wenzhou Medical University, 270 Xueyuan Xi Road, Wenzhou, Zhejiang 325027, PR China
| | - Yining Pan
- Institute of Advanced Materials for Nano-Bio Applications, School of Ophthalmology & Optometry, Eye Hospital, Wenzhou Medical University, 270 Xueyuan Xi Road, Wenzhou, Zhejiang 325027, PR China
| | - Ziru Lv
- Institute of Advanced Materials for Nano-Bio Applications, School of Ophthalmology & Optometry, Eye Hospital, Wenzhou Medical University, 270 Xueyuan Xi Road, Wenzhou, Zhejiang 325027, PR China
| | - Xiaoting Sun
- Institute of Advanced Materials for Nano-Bio Applications, School of Ophthalmology & Optometry, Eye Hospital, Wenzhou Medical University, 270 Xueyuan Xi Road, Wenzhou, Zhejiang 325027, PR China
| | - Hao Yu
- Institute of Advanced Materials for Nano-Bio Applications, School of Ophthalmology & Optometry, Eye Hospital, Wenzhou Medical University, 270 Xueyuan Xi Road, Wenzhou, Zhejiang 325027, PR China
| | - Jiangfan Chen
- Institute of Advanced Materials for Nano-Bio Applications, School of Ophthalmology & Optometry, Eye Hospital, Wenzhou Medical University, 270 Xueyuan Xi Road, Wenzhou, Zhejiang 325027, PR China.
| | - Qingqing Yao
- Institute of Advanced Materials for Nano-Bio Applications, School of Ophthalmology & Optometry, Eye Hospital, Wenzhou Medical University, 270 Xueyuan Xi Road, Wenzhou, Zhejiang 325027, PR China.
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Ryu J. New Aspects on the Treatment of Retinopathy of Prematurity: Currently Available Therapies and Emerging Novel Therapeutics. Int J Mol Sci 2022; 23:8529. [PMID: 35955664 PMCID: PMC9369302 DOI: 10.3390/ijms23158529] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 02/05/2023] Open
Abstract
Retinopathy of prematurity (ROP) is a rare proliferative ocular disorder in preterm infants. Because of the advancements in neonatal care, the incidence of ROP has increased gradually. Now, ROP is one of the leading causes of blindness in children. Preterm infants with immature retinal development are exposed to supplemental oxygen inside an incubator until their cardiopulmonary system is adequately developed. Once they are returned to room air, the relatively low oxygen level stimulates various angiogenesis factors initiating retinal neovascularization. If patients with ROP are not offered adequate and timely treatment, they can experience vision loss that may ultimately lead to permanent blindness. Although laser therapy and anti-vascular endothelial growth factor agents are widely used to treat ROP, they have limitations. Thus, it is important to identify novel therapeutics with minimal adverse effects for the treatment of ROP. To date, various pharmacologic and non-pharmacologic therapies have been assessed as treatments for ROP. In this review, the major molecular factors involved in the pathogenesis of ROP, currently offered therapies, therapies under investigation, and emerging novel therapeutics of ROP are discussed.
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Affiliation(s)
- Juhee Ryu
- Vessel-Organ Interaction Research Center, College of Pharmacy, Kyungpook National University, Daegu 41566, Korea; ; Tel.: +82-539508583
- Research Institute of Pharmaceutical Sciences, College of Pharmacy, Kyungpook National University, Daegu 41566, Korea
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25
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Chow SC, Lam PY, Lam WC, Fung NSK. The role of anti-vascular endothelial growth factor in treatment of retinopathy of prematurity-a current review. Eye (Lond) 2022; 36:1532-1545. [PMID: 35017699 PMCID: PMC9307789 DOI: 10.1038/s41433-021-01922-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 11/27/2021] [Accepted: 12/22/2021] [Indexed: 11/08/2022] Open
Abstract
The review aims to evaluate the uses of conventional laser therapy and intravitreal injection of various anti-VEGF in terms of efficacy and side effects for the treatment of retinopathy of prematurity. A literature search of the publication, concerning conventional laser treatment and intravitreal injection of anti-VEGF for ROP. A total of 40 articles were reviewed after curation by the authors for relevance. Intravitreal anti-VEGF showed better ocular efficacy in zone I ROP while laser therapy had a lower recurrence rate in zone II. Comparing the two mainstay anti-VEGF agents, bevacizumab showed lower ROP recurrence rate than ranibizumab. Anti-VEGF has a higher chance in developing persistent peripheral avascularisation compared to conventional laser therapy, but a lower chance of developing high myopia. Ranibizumab has a lower systemic absorption than bevacizumab, despite having no difference in the incidence of persistent peripheral avascularisation. In conclusion, it is advised that intravitreal anti-VEGF should be used as the first-line treatment for zone I ROP while laser therapy should be the mainstay for zone II ROP owing to the different pathogenetic mechanisms. In patients with recurrence after initial anti-VEGF injection, that given ranibizumab may opt to repeat the injection while that given bevacizumab should consider supplement laser ablative treatment.
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Affiliation(s)
- Shing Chuen Chow
- The Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Pun Yuet Lam
- The Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Wai Ching Lam
- The Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
- Queen Mary Hospital & Grantham Hospital, Pok Fu Lam, Hong Kong
| | - Nicholas Siu Kay Fung
- The Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong.
- Queen Mary Hospital & Grantham Hospital, Pok Fu Lam, Hong Kong.
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National guideline for ophthalmological screening of premature infants in Germany (S2k level, AWMF guidelines register no. 024/010, March 2020) : Joint recommendation of the German Ophthalmological Society (DOG), German Retina Society (RG), Professional Association of Ophthalmologists in Germany (BVA), German Society of Pediatrics and Adolescent Medicine (DGKJ), Professional Association of Pediatricians (BVKJ), Federal Association "The Premature Infant", Society for Neonatology and Pediatric Intensive Care Medicine (GNPI). DIE OPHTHALMOLOGIE 2022; 119:123-136. [PMID: 35507084 DOI: 10.1007/s00347-022-01632-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/25/2022] [Indexed: 01/25/2023]
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27
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Gundlach BS, Kokhanov A, Altendahl M, Suh SY, Fung S, Demer J, Pineles S, Khitri M, Chu A, Tsui I. Real-World Visual Outcomes of Laser and Anti-VEGF Treatments for Retinopathy of Prematurity. Am J Ophthalmol 2022; 238:86-96. [PMID: 34788594 DOI: 10.1016/j.ajo.2021.11.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 11/07/2021] [Accepted: 11/08/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE To characterize visual outcomes in children screened for retinopathy of prematurity (ROP). DESIGN Retrospective, interventional case series. METHODS Patients who received ROP screening examinations at UCLA Medical Centers and were followed with outpatient eye examinations at Stein Eye Institute and/or Doheny Eye Institute (Los Angeles, California) were included. Data were collected on birth characteristics, worst type of ROP, and ROP treatment. Adverse visual outcomes included myopia, strabismus, amblyopia, macular dragging, and optic atrophy. Snellen visual acuity was reported for children 4 years and older. RESULTS A total of 175 infants (350 eyes) were included for analysis (mean gestational age = 28.2 weeks and birth weight = 1059 g) from a screening population of 539 infants (1078 eyes, 32.4% follow-up) over a 9-year period. Fifteen eyes received primary anti-vascular endothelial growth factor (anti-VEGF) therapy, whereas 59 eyes received primary laser therapy. Primary anti-VEGF therapy, as compared with primary laser treatment, was associated with a decreased incidence of amblyopia (adjusted odds ratio [aOR] = 0.6-0.86, P < .0001) after controlling for gestational age and birth weight. The rates of optic atrophy (P = .79), strabismus (P = .98), and myopia (P = .93) were not different between anti-VEGF and laser treatment groups. Infants receiving anti-VEGF therapy had more posterior disease than laser-treated infants (P = .041). Infants receiving laser therapy were more likely to have severe myopia (aOR = 1.02-1.3, P = .023), amblyopia (aOR = 1.12-1.61, P = .002), and optic atrophy (aOR = 1.01-1.32, P = .045) than infants not treated. CONCLUSION These findings add to the advantages of anti-VEGF treatment compared with primary laser treatment, particularly in posterior ROP.
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Affiliation(s)
- Bradley S Gundlach
- From the Department of Ophthalmology (B.S.G., S.Y.S., S.F., J.D., S.P., M.K., I.T.), University of California Los Angeles, Los Angeles, California, USA
| | - Artemiy Kokhanov
- Department of Pediatrics, Division of Neonatology and Developmental Biology (A.K., M.A., A.C.), University of California Los Angeles, Los Angeles, California, USA
| | - Marie Altendahl
- Department of Pediatrics, Division of Neonatology and Developmental Biology (A.K., M.A., A.C.), University of California Los Angeles, Los Angeles, California, USA
| | - Soh Youn Suh
- From the Department of Ophthalmology (B.S.G., S.Y.S., S.F., J.D., S.P., M.K., I.T.), University of California Los Angeles, Los Angeles, California, USA
| | - Simon Fung
- From the Department of Ophthalmology (B.S.G., S.Y.S., S.F., J.D., S.P., M.K., I.T.), University of California Los Angeles, Los Angeles, California, USA
| | - Joseph Demer
- From the Department of Ophthalmology (B.S.G., S.Y.S., S.F., J.D., S.P., M.K., I.T.), University of California Los Angeles, Los Angeles, California, USA; Department of Neurology (J.D.), University of California Los Angeles, Los Angeles, California, USA; Department of Bioengineering (J.D.), University of California Los Angeles, Los Angeles, California, USA; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Stacy Pineles
- From the Department of Ophthalmology (B.S.G., S.Y.S., S.F., J.D., S.P., M.K., I.T.), University of California Los Angeles, Los Angeles, California, USA
| | - Monica Khitri
- From the Department of Ophthalmology (B.S.G., S.Y.S., S.F., J.D., S.P., M.K., I.T.), University of California Los Angeles, Los Angeles, California, USA
| | - Alison Chu
- Department of Pediatrics, Division of Neonatology and Developmental Biology (A.K., M.A., A.C.), University of California Los Angeles, Los Angeles, California, USA
| | - Irena Tsui
- From the Department of Ophthalmology (B.S.G., S.Y.S., S.F., J.D., S.P., M.K., I.T.), University of California Los Angeles, Los Angeles, California, USA.
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Biomarkers as Predictive Factors of Anti-VEGF Response. Biomedicines 2022; 10:biomedicines10051003. [PMID: 35625740 PMCID: PMC9139112 DOI: 10.3390/biomedicines10051003] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/13/2022] [Accepted: 04/22/2022] [Indexed: 02/04/2023] Open
Abstract
Age-related macular degeneration is the main cause of irreversible vision in developed countries, and intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections are the current gold standard treatment today. Although anti-VEGF treatment results in important improvements in the course of this disease, there is a considerable number of patients not responding to the standardized protocols. The knowledge of how a patient will respond or how frequently retreatment might be required would be vital in planning treatment schedules, saving both resource utilization and financial costs, but today, there is not an ideal biomarker to use as a predictive response to ranibizumab therapy. Whole blood and blood mononuclear cells are the samples most studied; however, few reports are available on other important biofluid samples for studying this disease, such as aqueous humor. Moreover, the great majority of studies carried out to date were focused on the search for SNPs in genes related to AMD risk factors, but miRNAs, proteomic and metabolomics studies have rarely been conducted in anti-VEGF-treated samples. Here, we propose that genomic, proteomic and/or metabolomic markers could be used not alone but in combination with other methods, such as specific clinic characteristics, to identify patients with a poor response to anti-VEGF treatment to establish patient-specific treatment plans.
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Neurovascular abnormalities in retinopathy of prematurity and emerging therapies. J Mol Med (Berl) 2022; 100:817-828. [PMID: 35394143 DOI: 10.1007/s00109-022-02195-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/01/2022] [Accepted: 03/28/2022] [Indexed: 10/18/2022]
Abstract
Blood vessels in the developing retina are formed in concert with neural growth, resulting in functional neurovascular network. Disruption of the neurovascular coordination contributes to the pathogenesis of retinopathy of prematurity (ROP), a potentially blinding retinal neovascular disease in preterm infants that currently lacks an approved drug therapy in the USA. Despite vasculopathy as predominant clinical manifestations, an increasing number of studies revealed complex neurovascular interplays among neurons, glial cells and blood vessels during ROP. Coordinated expression of glia-derived vascular endothelial growth factor (VEGF) in spatio-temporal gradients is pivotal to the formation of well-organized vascular plexuses in the healthy retina, whereas uncoordinated VEGF expression triggers pathological angiogenesis with disorganized vascular tufts in ROP. In contrast with VEGF driving both pathological and physiological angiogenesis, neuron-derived angiogenic factor secretogranin III (Scg3) stringently regulates ROP but not healthy retinal vessels in animal models. Anti-VEGF and anti-Scg3 therapies confer similar high efficacies to alleviate ROP in preclinical studies but are distinct in their disease selectivity and safety. This review discusses neurovascular communication among retinal blood vessels, neurons and glial cells during retinal development and ROP pathogenesis and summarizes the current and emerging therapies to address unmet clinical needs for the disease.
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Süren E, Özkaya D, Çetinkaya E, Kalaycı M, Yiğit K, Kücük MF, Erol MK. Comparison of bevacizumab, ranibizumab and aflibercept in retinopathy of prematurity treatment. Int Ophthalmol 2022; 42:1905-1913. [DOI: 10.1007/s10792-021-02188-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 12/18/2021] [Indexed: 11/29/2022]
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Tsai AS, Chou HD, Ling XC, Al-Khaled T, Valikodath N, Cole E, Yap VL, Chiang MF, Chan RVP, Wu WC. Assessment and management of retinopathy of prematurity in the era of anti-vascular endothelial growth factor (VEGF). Prog Retin Eye Res 2021; 88:101018. [PMID: 34763060 DOI: 10.1016/j.preteyeres.2021.101018] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 02/06/2023]
Abstract
The incidence of retinopathy of prematurity (ROP) continues to rise due to the improved survival of very low birth weight infants in developed countries. This epidemic is also fueled by increased survival of preterm babies with variable use of oxygen and a lack of ROP awareness and screening services in resource-limited regions. Improvements in technology and a basic understanding of the disease pathophysiology have changed the way we screen and manage ROP, educate providers and patients, and improve ROP awareness. Advancements in imaging techniques, expansion of telemedicine services, and the potential for artificial intelligence-assisted ROP screening programs have created opportunities to improve ROP care in areas with a shortage of ophthalmologists trained in ROP. To address the gap in provider knowledge regarding ROP, the Global Education Network for Retinopathy of Prematurity (GEN-ROP) created a web-based tele-education training module that can be used to educate all providers involved in ROP, including non-physician ROP screeners. Over the past 50 years, the treatment of severe ROP has evolved from limited treatment modalities to cryotherapy and laser photocoagulation. More recently, there has been growing evidence to support the use of anti-vascular endothelial growth factor (VEGF) agents for the treatment of severe ROP. However, VEGF is known to be important in organogenesis and microvascular maintenance, and given that intravitreal anti-VEGF treatment can result in systemic VEGF suppression over a period of at least 1-12 weeks, there are concerns regarding adverse effects and long-term ocular and systemic developmental consequences of anti-VEGF therapy. Future research in ophthalmology to address the growing burden of ROP should focus on cost-effective fundus imaging devices, implementation of artificial intelligence platforms, updated treatment algorithms with optimal use of anti-VEGF and careful investigation of its long-term effects, and surgical options in advanced ROP. Addressing these unmet needs will aid the global effort against the ROP epidemic and optimize our understanding and treatment of this blinding disease.
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Affiliation(s)
- Andrew Sh Tsai
- Singapore National Eye Centre, Singapore; DUKE NUS Medical School, Singapore
| | - Hung-Da Chou
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Xiao Chun Ling
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Tala Al-Khaled
- Department of Ophthalmology & Visual Sciences, University of Illinois at Chicago, Illinois Eye and Ear Infirmary, Chicago, IL, USA
| | - Nita Valikodath
- Department of Ophthalmology & Visual Sciences, University of Illinois at Chicago, Illinois Eye and Ear Infirmary, Chicago, IL, USA
| | - Emily Cole
- Department of Ophthalmology & Visual Sciences, University of Illinois at Chicago, Illinois Eye and Ear Infirmary, Chicago, IL, USA
| | - Vivien L Yap
- Division of Newborn Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Michael F Chiang
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - R V Paul Chan
- Department of Ophthalmology & Visual Sciences, University of Illinois at Chicago, Illinois Eye and Ear Infirmary, Chicago, IL, USA.
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Yang X, Wang J, Chen C. Serum VEGF and Ang-2 Levels in Infants Before and After Laser Treatment for Retinopathy of Prematurity. Fetal Pediatr Pathol 2021; 40:407-413. [PMID: 32075465 DOI: 10.1080/15513815.2020.1721625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
To investigate VEGF and Ang-2 level changes in the systemic circulation after laser photocoagulation in premature infants with ROP. Methods: Eleven infants (4 girls and 7 boys) had serum levels determined for VEGF and Ang-2, collected 1 day prior to and 7 days after ROP laser therapy. Serum levels of VEGF and Ang-2 were quantified by enzyme-linked immunosorbent assay (ELISA). Results: Serum VEGF levels were significantly lower at 7 days after laser therapy compared to that at 1 day prior to laser therapy (p = 0.045). Serum Ang-2 levels increased significantly at 7 days after laser therapy compared with that at 1 day prior to laser therapy (p = 0.046). Conclusions: Serum VEGF levels in patients with ROP were suppressed and Ang-2 levels elevated significantly after laser therapy. The results suggest that changes in VEGF and Ang-2 serum levels may reflect regression and treatment of ROP.
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Affiliation(s)
- Xiaofeng Yang
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China.,Key Laboratory of Neonatal Disease, Ministry of Health, Shanghai, China.,Department of Neonatology, Children's Hospital of Soochow University, Suzhou, Jiangsu province, China
| | - Junping Wang
- Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, Guangdong province, China
| | - Chao Chen
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China.,Key Laboratory of Neonatal Disease, Ministry of Health, Shanghai, China
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Tan H, Blasco P, Lewis T, Ostmo S, Chiang MF, Campbell JP. Neurodevelopmental outcomes in preterm infants with retinopathy of prematurity. Surv Ophthalmol 2021; 66:877-891. [PMID: 33667496 PMCID: PMC8351023 DOI: 10.1016/j.survophthal.2021.02.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/15/2021] [Accepted: 02/23/2021] [Indexed: 11/26/2022]
Abstract
Over the past decade there has been a paradigm shift in the treatment of retinopathy of prematurity (ROP) with the introduction of antivascular endothelial growth factor (anti-VEGF) treatments. Anti-VEGF agents have the advantages of being easier to administer, requiring less anesthesia, having the potential for improved peripheral vision, and producing less refractive error than laser treatment. On the other hand, it is known that intravitreal administration of anti-VEGF agents lowers VEGF levels in the blood and raises the theoretical concern of intraocular anti-VEGF causing deleterious effects in other organ systems, including the brain. As a result, there has been increased attention recently on neurodevelopmental outcomes in infants treated with anti-VEGF agents. These studies should be put into context with what is known about systemic comorbidities, socioeconomic influences, and the effects of extreme prematurity itself on neurodevelopmental outcomes. We summarize what is known about neurodevelopmental outcomes in extremely preterm infants with ROP, discuss the implications for determining the neurodevelopmental status using neurodevelopmental testing as well as other indicators, and review the existing literature relating to neurodevelopmental outcomes in babies treated for ROP.
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Affiliation(s)
- Hao Tan
- Casey Eye Institute, Department of Ophthalmology, Oregon Health and Science University, Portland, OR, USA
| | - Patricia Blasco
- Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA
| | - Tamorah Lewis
- Children's Mercy Hospital, Divisions of Neonatology and Pediatric Clinical Pharmacology, University of Missouri Kansas City, Kansas City, MO, USA
| | - Susan Ostmo
- Casey Eye Institute, Department of Ophthalmology, Oregon Health and Science University, Portland, OR, USA
| | - Michael F Chiang
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - John Peter Campbell
- Casey Eye Institute, Department of Ophthalmology, Oregon Health and Science University, Portland, OR, USA.
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Zayek M, Parker K, Rydzewska M, Rifai A, Bhat R, Eyal F. Bevacizumab for Retinopathy of Prematurity: 2-Year Neurodevelopmental Follow-up. Am J Perinatol 2021; 38:1158-1166. [PMID: 32446264 DOI: 10.1055/s-0040-1710556] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This study aimed to determine whether infants who were treated with intravitreal bevacizumab (IVB) for retinopathy of prematurity (ROP) were at higher risk of death or neurodevelopmental impairment (NDI) when compared with infants who were not treated with IVB (Laser only). STUDY DESIGN This retrospective study included 146 infants born from 2009 through 2016 with a birth weight (BW) <1,000 g, gestational age <27 weeks, and required ROP therapy. Death and NDI rates were assessed at 18 to 24 months' corrected age. RESULTS Rates of death or severe NDI were 62 and 53% in the IVB (n = 61) and Laser only (n = 85) groups, respectively. This difference was not statistically different despite sample selection bias in treating growth-restricted infants with IVB, BW (median [IQR]) was 481 (420-583) versus 547 (473-640) g in IVB and Laser only groups, respectively, p = 0.003. The adjusted odds ratio and 95% confidence interval of death or severe NDI was 0.86 (0.33-2.20). CONCLUSION Bevacizumab therapy for ROP did not affect survival and neurodevelopment of extremely preterm infants. KEY POINTS · Intravitreal bevacizumab therapy for retinopathy of prematurity may be safe in periviable preterm infants.. · Intravitreal bevacizumab therapy does not increase mortality rate in periviable preterm infants.. · Intravitreal bevacizumab therapy does not increase adverse neurodevelopmental outcome in periviable infants..
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Affiliation(s)
- Michael Zayek
- Division of Neonatology, Department of Pediatrics, University of South Alabama, Mobile, Alabama
| | - Kaitlyn Parker
- Division of Neonatology, Department of Pediatrics, University of South Alabama, Mobile, Alabama
| | - Monika Rydzewska
- Department of Pediatrics, Neonatal Medicine, Crozer-Keystone Health System, Upland, Pennsylvania
| | - Aref Rifai
- Retina Center of Pensacola, Pensacola, Florida
| | - Ramachandra Bhat
- Division of Neonatology, Department of Pediatrics, University of South Alabama, Mobile, Alabama
| | - Fabien Eyal
- Division of Neonatology, Department of Pediatrics, University of South Alabama, Mobile, Alabama
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Ittarat M. Comparison of Outcomes Between Combined Sparing Laser Photocoagulation and Intravitreal Bevacizumab Treatment Versus Conventional Laser Photocoagulation in Aggressive Posterior Retinopathy of Prematurity. J Pediatr Ophthalmol Strabismus 2021; 58:292-297. [PMID: 34180288 DOI: 10.3928/01913913-20210316-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To report the clinical outcomes of combined sparing laser photocoagulation and intravitreal bevacizumab treatment compared to conventional laser photocoagulation for the treatment of aggressive posterior retinopathy of prematurity (APROP). METHODS A medical chart review was performed on all consecutive eyes with APROP that were treated with conventional laser photocoagulation or laser photocoagulation and intravitreal bevacizumab (IVB) injection between July 2019 and August 2020. The data were recorded for time to reversal of plus disease, time to total regression of retinopathy of prematurity (ROP) after intervention, total laser spots and area, proportion of eyes with satisfactory anatomical outcomes, and adverse events. Outcomes of the two groups were compared. RESULTS Sixteen eyes of 8 infants with APROP were included in the analysis. Eight eyes of 4 infants received combined sparing laser photocoagulation and IVB treatment, and 8 eyes of 4 infants received conventional laser photocoagulation. All 8 eyes in the combined treatment group and 6 of 8 eyes in the conventional treatment group showed regression of ROP with a satisfactory anatomical outcome. The average time to total regression of ROP was 34 days in the combined treatment group and 56 days in the conventional treatment group (P = .005). The number of laser spots was significantly lower in the combined treatment group (P = .03). CONCLUSIONS Combined sparing laser photocoagulation and IVB treatment for eyes with APROP achieved ROP regression twice as fast, had fewer laser spots, and had a satisfactory anatomical outcome in comparison to conventional laser photocoagulation. [J Pediatr Ophthalmol Strabismus. 2021;58(5):292-297.].
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Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize complications of treatment for retinopathy of prematurity (ROP) and to compare complications of laser and intravitreal antivascular endothelial growth factor (VEGF) injections. RECENT FINDINGS Poor structural outcomes and myopia are more common with laser for severe ROP than with anti-VEGF. Clinical trial data show unfavourable outcomes in 9.1-9.5% of laser treated, and 1.4-3.6% of anti-VEGF treated eyes. Additional randomized trial data show risk for very high myopia (≥-8.00D) to be 3.8 and 51.4% for zone I eyes treated with bevacizumab and laser, respectively. However, anti-VEGF may be complicated by late recurrence and is more likely to require retreatment than laser. Laser often necessitates general anaesthesia with its attendant risks, including worse short-term respiratory outcomes. Neurodevelopmental complications have been reported with anti-VEGF, but existing studies are subject to bias. SUMMARY Treatment complications are substantially different for the two modalities in common use today. In more severe cases, risk of poor structural outcome and myopia favour treatment with anti-VEGF. In less severe ROP, risk of recurrence and the need for additional treatments may favour laser. Additional data are needed to establish comparative risks of neurodevelopmental complications.
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Affiliation(s)
- Joshua M Barnett
- The Emory Eye Center, Emory University School of Medicine, Atlanta, Georgia, USA
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Sindal MD, Yadav D. Commentary: Are we there yet? Role of anti-vascular endothelial growth factor and laser in the management of retinopathy of prematurity. Indian J Ophthalmol 2021; 69:2176-2177. [PMID: 34304204 PMCID: PMC8482901 DOI: 10.4103/ijo.ijo_626_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Manavi D Sindal
- Vitreo-Retina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India
| | - Divya Yadav
- Vitreo-Retina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India
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Gangwe AB, Agrawal D, Gangrade AK, Parchand SM, Agrawal D, Azad RV. Outcomes of early versus deferred laser after intravitreal ranibizumab in aggressive posterior retinopathy of prematurity. Indian J Ophthalmol 2021; 69:2171-2176. [PMID: 34304203 PMCID: PMC8482928 DOI: 10.4103/ijo.ijo_3016_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose: The aim of this study was to report the treatment outcomes of early and deferred laser in infants of aggressive posterior retinopathy of prematurity (APROP) after initial treatment with intravitreal Ranibizumab (IVR). Methods: In a prospective, randomized, interventional study, infants with APROP received IVR (0.25 mg) and were randomized into two groups prior to laser. Laser was done at 1 week (group 1) or at 6 weeks or earlier if there was a recurrence of plus disease (group 2). The structural outcome, number of laser spots, duration of laser procedure and refractive error at 6 months were compared. Favorable structural outcome was defined as, complete regression of disease at 6 weeks after laser. Results: 63 eyes of 32 infants with APROP were enrolled. Mean gestational age (GA) and birth weight (BW) were 30.2 ± 2.3 weeks and 1294 ± 372.8 grams respectively. GA, BW, and disease severity were comparable at baseline. 27 (90%) eyes in group 1 and 29 (93.5%) eyes in group 2 had favorable structural outcome (P = 0.61) at 6 weeks after laser. Eyes in group 2 (2149.8 ± 688.7) required lesser number of laser spots than group 1 (2570.8 ± 615) (P = 0.01). At six months, more eyes in group 1 had myopic refractive error (Mean spherical equivalent: –1.0D ± 1.3) than those in group 2 (Mean spherical equivalent: 0.5D ± 1.9) (P = 0.002). Conclusion: Infants with APROP receiving IVR have comparable structural outcomes after an early or deferred laser. Moreover, eyes undergoing deferred laser require less number of laser spots and have a less myopia at 6 months after laser.
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Affiliation(s)
- Anil Babanrao Gangwe
- Consultant Vitreo Retina Services, Vitreoretina Services, Raipur, Chhattisgarh, India
| | | | | | | | - Deepanshu Agrawal
- Consultant Vitreo Retina Services, Vitreoretina Services, Raipur, Chhattisgarh, India
| | - Raj Vardhan Azad
- Professor of Ophthalmology, Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
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Ray SK, Manz SN. BRAIN HEALTH ASSESSMENT IN MACULAR DEGENERATION PATIENTS UNDERGOING INTRAVITREAL ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR INJECTIONS (THE BHAM STUDY): An Interim Analysis. Retina 2021; 41:1748-1753. [PMID: 33346625 DOI: 10.1097/iae.0000000000003066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE After intravitreal injection, anti-vascular endothelial growth factor (VEGF) agents are found in the systemic circulation and can suppress systemic VEGF levels. Neuronal health and cognitive function in the central nervous system have been associated with normal physiological levels of VEGF expression. We wished to determine whether there was an association between cumulative anti-VEGF exposure and cognitive function. METHODS One hundred and seventy-five patients aged 65 to 85 with vision of at least 20/50 or better in one eye and a diagnosis of age-related macular degeneration took an iPad-based brain health assessment to determine their risk of mild cognitive impairment. The result for each patient was compared with the total number of anti-VEGF injections per individual patient. Patients were then stratified into groups with 0 injections (control), 1 to 9 injections, 10 to 20 injections, or greater than 20 injections. RESULTS The group of patients with more than 20 injections had a higher likelihood of mild cognitive impairment compared with the control group, with statistically significant worse mean Z-scores (P = 0.04). CONCLUSION Our study is the first to associate worsening cognitive health with higher cumulative anti-VEGF injections. This study was not designed to show a causal link, but does suggest that additional investigation is warranted.
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Dai C, Webster KA, Bhatt A, Tian H, Su G, Li W. Concurrent Physiological and Pathological Angiogenesis in Retinopathy of Prematurity and Emerging Therapies. Int J Mol Sci 2021; 22:4809. [PMID: 34062733 PMCID: PMC8124946 DOI: 10.3390/ijms22094809] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/27/2021] [Accepted: 04/29/2021] [Indexed: 12/11/2022] Open
Abstract
Retinopathy of prematurity (ROP) is an ocular vascular disease affecting premature infants, characterized by pathological retinal neovascularization (RNV), dilated and tortuous retinal blood vessels, and retinal or vitreous hemorrhages that may lead to retinal detachment, vision impairment and blindness. Compared with other neovascular diseases, ROP is unique because of ongoing and concurrent physiological and pathological angiogenesis in the developing retina. While the disease is currently treated by laser or cryotherapy, anti-vascular endothelial growth factor (VEGF) agents have been extensively investigated but are not approved in the U.S. because of safety concerns that they negatively interfere with physiological angiogenesis of the developing retina. An ideal therapeutic strategy would selectively inhibit pathological but not physiological angiogenesis. Our group recently described a novel strategy that selectively and safely alleviates pathological RNV in animal models of ROP by targeting secretogranin III (Scg3), a disease-restricted angiogenic factor. The preclinical profile of anti-Scg3 therapy presents a high potential for next-generation disease-targeted anti-angiogenic therapy for the ROP indication. This review focuses on retinal vessel development in neonates, the pathogenesis of ROP and its underlying molecular mechanisms, including different animal models, and provides a summary of current and emerging therapies.
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Affiliation(s)
- Chang Dai
- Department of Ophthalmology, Baylor College of Medicine, Houston, TX 77030, USA; (C.D.); (K.A.W.); (A.B.)
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun 130041, China
| | - Keith A. Webster
- Department of Ophthalmology, Baylor College of Medicine, Houston, TX 77030, USA; (C.D.); (K.A.W.); (A.B.)
- Department of Pharmacology, University of Miami School of Medicine, Miami, FL 33136, USA
- Everglades Biopharma, LLC, Houston, TX 77030, USA;
| | - Amit Bhatt
- Department of Ophthalmology, Baylor College of Medicine, Houston, TX 77030, USA; (C.D.); (K.A.W.); (A.B.)
- Texas Children Hospital, Baylor College of Medicine, Houston, TX 77030, USA
| | - Hong Tian
- Everglades Biopharma, LLC, Houston, TX 77030, USA;
| | - Guanfang Su
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun 130041, China
| | - Wei Li
- Department of Ophthalmology, Baylor College of Medicine, Houston, TX 77030, USA; (C.D.); (K.A.W.); (A.B.)
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[Guidelines for ophthalmological screening of premature infants in Germany (S2k level, AWMF guidelines register no. 024/010, March 2020) : Joint recommendation of the German Ophthalmological Society (DOG), Retinological Society (RG), Professional Association of Ophthalmologists in Germany e. V. (BVA), German Society of Paediatrics and Adolescent Medicine (DGKJ), Professional Association of Pediatricians (BVKJ), Federal Association "The Premature Child" , Society for Neonatology and Paediatric Intensive Care Medicine (GNPI)]. Ophthalmologe 2021; 118:117-131. [PMID: 33694101 DOI: 10.1007/s00347-021-01353-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2021] [Indexed: 12/20/2022]
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Arima M, Fujii Y, Sonoda KH. Translational Research in Retinopathy of Prematurity: From Bedside to Bench and Back Again. J Clin Med 2021; 10:331. [PMID: 33477419 PMCID: PMC7830975 DOI: 10.3390/jcm10020331] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/09/2021] [Accepted: 01/15/2021] [Indexed: 12/11/2022] Open
Abstract
Retinopathy of prematurity (ROP), a vascular proliferative disease affecting preterm infants, is a leading cause of childhood blindness. Various studies have investigated the pathogenesis of ROP. Clinical experience indicates that oxygen levels are strongly correlated with ROP development, which led to the development of oxygen-induced retinopathy (OIR) as an animal model of ROP. OIR has been used extensively to investigate the molecular mechanisms underlying ROP and to evaluate the efficacy of new drug candidates. Large clinical trials have demonstrated the efficacy of anti-vascular endothelial growth factor (VEGF) agents to treat ROP, and anti-VEGF therapy is presently becoming the first-line treatment worldwide. Anti-VEGF therapy has advantages over conventional treatments, including being minimally invasive with a low risk of refractive error. However, long-term safety concerns and the risk of late recurrence limit this treatment. There is an unmet medical need for novel ROP therapies, which need to be addressed by safe and minimally invasive therapies. The recent progress in biotechnology has contributed greatly to translational research. In this review, we outline how basic ROP research has evolved with clinical experience and the subsequent emergence of new drugs. We discuss previous and ongoing trials and present the candidate molecules expected to become novel targets.
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Affiliation(s)
- Mitsuru Arima
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 8128582, Japan; (Y.F.); (K.-H.S.)
- Center for Clinical and Translational Research, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka 8128582, Japan
| | - Yuya Fujii
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 8128582, Japan; (Y.F.); (K.-H.S.)
| | - Koh-Hei Sonoda
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 8128582, Japan; (Y.F.); (K.-H.S.)
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Maier RF, Hummler H, Kellner U, Krohne TU, Lawrenz B, Lorenz B, Mitschdörfer B, Roll C, Stahl A. Augenärztliche Screening-Untersuchung bei Frühgeborenen (S2k-Level, AWMF-Leitlinien-Register-Nr. 024/010, März 2020). Z Geburtshilfe Neonatol 2021; 225:19-33. [PMID: 33450782 DOI: 10.1055/a-1248-0649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Rolf F Maier
- Zentrum für Kinder- und Jugendmedizin Marburg, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg
| | | | - Ulrich Kellner
- Augenzentrum Siegburg, MVZ Augenärztliches Diagnostik- und Therapiecentrum Siegburg GmbH
| | | | - Burkhard Lawrenz
- Privatpraxis für Kinder- und Jugendmedizin Dr. med. Burkhard Lawrenz, Arnsberg
| | - Birgit Lorenz
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen, Justus-Liebig-Universität Gießen
| | | | - Claudia Roll
- Abteilung für Neonatologie, Pädiatrische Intensivmedizin, Schlafmedizin, Vestische Kinder- und Jugendklinik Datteln, Universität Witten/Herdecke
| | - Andreas Stahl
- Klinik und Poliklinik für Augenheilkunde, Universitätsmedizin Greifswald
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Abstract
Ranibizumab (Lucentis®) is a monoclonal antibody fragment targeted against VEGF-A that is the first approved anti-VEGF agent for the treatment of retinopathy of prematurity (ROP). In the pivotal, randomized, phase III RAINBOW trial in infants with ROP, the majority of intravitreal ranibizumab recipients experienced treatment success at 24 weeks, with a numerically greater treatment success rate in the ranibizumab 0.2 mg (80% of patients) than laser therapy (66%) group without reaching statistical significance for superiority. Long-term effects on vision following ranibizumab treatment are not yet known, but interim analyses from the RAINBOW extension study do not show evidence of degraded vision. Adverse reactions to ranibizumab in pediatric patients were consistent with the known safety profile in adults, with most adverse reactions attributed to the intravitreal injection procedure. Furthermore, systemic VEGF suppression was not observed in clinical trials, which is congruent with the rapid systemic clearance of ranibizumab. Overall, ranibizumab is an effective and generally well tolerated treatment for ROP and is not associated with systemic VEGF suppression. Although results for its long-term effects on vision are not yet available, ranibizumab is a promising alternative option to laser therapy for treating ROP.
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Affiliation(s)
- Arnold Lee
- Springer Nature, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand.
| | - Matt Shirley
- Springer Nature, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand
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Barry GP, Yu Y, Ying GS, Tomlinson LA, Lajoie J, Fisher M, Binenbaum G. Retinal Detachment after Treatment of Retinopathy of Prematurity with Laser versus Intravitreal Anti-Vascular Endothelial Growth Factor. Ophthalmology 2020; 128:1188-1196. [PMID: 33387554 DOI: 10.1016/j.ophtha.2020.12.028] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 12/10/2020] [Accepted: 12/28/2020] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To compare rates of short-term retinal detachment (RD) of infants treated for type 1 retinopathy of prematurity (ROP) with intravitreal anti-vascular endothelial growth factor (VEGF) therapy with infants treated with laser therapy. The choice between these 2 treatments remains controversial. Comparative data are limited and describe re-treatment rates rather than retinal structural outcomes predictive of long-term vision. Anti-vascular endothelial growth factor acts faster than laser therapy, which may be beneficial for more aggressive ROP. DESIGN Nonrandomized, comparative cohort study. PARTICIPANTS The study included 1167 eyes of 640 infants treated for type 1 ROP. Among these, 164 eyes received anti-VEGF therapy and 1003 eyes received laser therapy. METHODS Pretreatment and posttreatment examinations and treatments were completed by ophthalmologists with expertise in ROP. The study was a secondary analysis of data from the retrospective Postnatal Growth and Retinopathy of Prematurity Study (G-ROP) 1 study (2006-2012) and the prospective G-ROP 2 study (2015-2017). MAIN OUTCOME MEASURES Rate of RD (ROP stages 4A, 4B, or 5) within 8 weeks of initial treatment, an end point predictive of poor long-term vision. The results were stratified by postmenstrual age (PMA) at treatment as occurring before versus at or after 36 weeks and 0 days, because earlier disease may be considered more aggressive. RESULTS Among 458 eyes treated before PMA 36 weeks and 0 days, the short-term RD rate was higher after laser therapy (29/368 eyes [7.9%]) than after anti-VEGF therapy (0/90 eyes [0%]; P < 0.001). Of 709 eyes treated at or after PMA 36 weeks and 0 days, short-term RD risk did not differ between groups (laser [20/635 eyes], 3.1%; anti-VEGF [1/74 eyes], 1.4%; P = 0.27). CONCLUSIONS Anti-vascular endothelial growth factor therapy results in better short-term structural outcomes than laser therapy when type 1 ROP is treated before 36 weeks' PMA. After this age, both treatments have very low rates of short-term RD. The faster action of anti-VEGF agents likely is responsible for these findings.
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Affiliation(s)
- Gerard P Barry
- Albany Medical College, Department of Ophthalmology, Albany, New York.
| | - Yinxi Yu
- Center for Preventive Ophthalmology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gui-Shuang Ying
- Center for Preventive Ophthalmology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lauren A Tomlinson
- Children's Hospital of Philadelphia, Department of Ophthalmology, Philadelphia, Pennsylvania
| | - Juliann Lajoie
- Albany Medical College, Department of Ophthalmology, Albany, New York
| | - Marilyn Fisher
- Albany Medical College, Department of Pediatrics, Albany, New York
| | - Gil Binenbaum
- Children's Hospital of Philadelphia, Department of Ophthalmology, Philadelphia, Pennsylvania
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Tsai CY, Yeh PT, Tsao PN, Chung YCE, Chang YS, Lai TT. Neurodevelopmental Outcomes after Bevacizumab Treatment for Retinopathy of Prematurity: A Meta-analysis. Ophthalmology 2020; 128:877-888. [PMID: 33212122 DOI: 10.1016/j.ophtha.2020.11.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 10/01/2020] [Accepted: 11/09/2020] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To evaluate neurodevelopmental outcomes after intravitreal bevacizumab (IVB) therapy in retinopathy of prematurity (ROP) infants compared with those not exposed to IVB. CLINICAL RELEVANCE The primary concern regarding IVB treatment of ROP is the potential systemic side effects, especially the risk of causing severe neurodevelopmental impairment (sNDI). Results regarding neurodevelopmental outcomes after IVB therapy are conflicting. METHODS We conducted a meta-analysis and searched PubMed, Embase, and Web of Science for related publications from inception through March 12, 2020. The eligibility criteria were as follows: comparative studies of ROP patients that (1) included IVB as a treatment arm, (2) included a control group without bevacizumab treatment, and (3) reported on at least 1 neurodevelopmental outcome, such as sNDI, Bayley Scales of Infant and Toddler Development, Third Edition (Bayley III), composition scores, or cerebral palsy (CP). The primary outcome was sNDI, with the odds ratio (OR) calculated. Secondary outcomes were mean differences (MDs) for cognitive, language, and motor scores (Bayley III) and OR for CP. The quality of evidence was assessed using the Grades of Recommendation, Assessment, Development, and Evaluation approach. RESULTS Eight studies, 6 including laser-controlled ROP infants and 2 including ROP infants not requiring treatment, were included. The weighted OR for sNDI in the IVB group was 1.39 (95% confidence interval [CI], 0.98-1.97). The weighted MDs were -1.92 (95% CI, -4.73 to 0.88), -1.32 (95% CI, -4.65 to 1.99), and -3.66 (95% CI, -6.79 to -0.54) for cognitive, language, and motor scores in Bayley III, respectively. The OR for CP was 1.20 (95% CI, 0.56-2.55). No differences were observed between the preset subgroups comprising laser-controlled ROP infants and ROP infants not requiring treatment. The current quality of evidence was rated as low (sNDI and all Bayley III scores) to very low (CP). CONCLUSIONS Risk of sNDI was not increased in ROP patients after IVB treatment. Bayley III scores were similar in the IVB and control groups, except for a minor difference in motor performance. These findings suggest that the risk of additional sNDI after IVB treatment is low. Randomized trials are warranted to provide a higher quality of evidence.
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Affiliation(s)
- Chia-Ying Tsai
- Department of Ophthalmology, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan; School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan; Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Po-Ting Yeh
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Po-Nien Tsao
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan; Research Center for Developmental Biology & Regenerative Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Chu Ella Chung
- Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli, Taiwan
| | - Yu-Shan Chang
- Department of Pediatrics, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Tso-Ting Lai
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Seery CW, Betesh S, Guo S, Zarbin MA, Bhagat N, Wagner RS. Update on the Use of Anti-VEGF Drugs in the Treatment of Retinopathy of Prematurity. J Pediatr Ophthalmol Strabismus 2020; 57:351-362. [PMID: 33211892 DOI: 10.3928/01913913-20200824-02] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 04/30/2020] [Indexed: 11/20/2022]
Abstract
Retinopathy of prematurity (ROP) is one of the many significant consequences of premature birth and remains one of the leading causes of visual impairment in infants. Originally, cryotherapy was used to prevent the complications of vitreous hemorrhage and retinal detachment. Subsequently, laser photocoagulation, which is at least as effective and possibly safer than cryoretinopexy, was adopted as the primary treatment for type 1 ROP (stage 2 or 3 disease in zone II with plus disease or any stage disease in zone I with plus disease or stage 3 disease in zone I without plus disease). Laser therapy has been proven effective, and has a degree of permanence that is yet to be matched by alternative treatments, but can be associated with significant ocular side effects such as myopia. Treatment of type 1 ROP with anti-vascular endothelial growth factor (VEGF) agents seems to have fewer ocular side effects than laser ablation of the retina, particularly if used to treat type 1 ROP in zone I. However, ROP recurrence is a real threat after anti-VEGF therapy and long-term systemic side effects of this therapy remain under evaluation. This review focuses on the ophthalmic and systemic benefits and risks of anti-VEGF therapies for ROP as compared to retinal photocoagulation. Anti-VEGF therapies have dramatically altered the management of ROP and have also been shown to be beneficial with regard to the visual prognosis of patients with ROP, but patients so treated require frequent short- and long-term follow-up to detect and manage potential complications associated with this form of treatment. Such information also will allow clinicians to characterize the efficacy, side effect profile, and utility of intravitreal anti-VEGF agents for this condition. Prospective studies are needed to identify the optimum anti-VEGF drug and dose. [J Pediatr Ophthalmol Strabismus. 2020;57(6):351-362.].
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Hwang DK, Chang YL, Lin TC, Peng CH, Chien KH, Tsai CY, Chen SJ, Chen KH, Hsu MY. Changes in the Systemic Expression of Sirtuin-1 and Oxidative Stress after Intravitreal Anti-Vascular Endothelial Growth Factor in Patients with Retinal Vein Occlusion. Biomolecules 2020; 10:biom10101414. [PMID: 33036304 PMCID: PMC7601748 DOI: 10.3390/biom10101414] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 09/30/2020] [Accepted: 10/02/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Retinal vein occlusions (RVO) are associated with systemic risk factors. However, the ocular occlusive events might also influence a patient's systemic condition. This study tried to investigate serum biomarkers associated with oxidative stress, before and after intravitreal anti-vascular endothelial growth factor (aVEGF) therapy in patients with RVOs. METHODS Newly-onset RVO patients were categorized into two groups: comorbid with macular edema requiring aVEGF therapy (treatment group) and no edema (observation group). Age and sex-matched patients (who received cataract surgery) were included as the control group. Intravitreal ranibizumab with a pro-re-nata regimen were administered. Serum samples were collected prior to treatment, at 6 and 12 months after therapy/observation and were collected once before controls who received cataract surgery. mRNA expression of sirtuin-1, its downstream genes, anti-oxidative biomarkers, and proinflammatory cytokines were measured. RESULTS There were 32, 26, and 34 patients enrolled in the treatment, observation, and control groups, respectively. The expressions of sirtuin-1 and its downstream genes were significantly lower in patients with RVO compared with the control group. Sirtuin-1 gene expression increased after 1 year of aVEGF therapy in the treatment group but remained unchanged in the observation group. Biomarkers of oxidative stress and proinflammatory cytokines were reduced after 1 year of aVEGF therapy. These biomarkers remained with no changes in the observation group. CONCLUSIONS Our study showed that the systemic oxidative stress increased in RVO patients. The aVEGF therapy could alter the gene expression of anti-oxidative proteins and reduce systemic oxidative stress in these patients.
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Affiliation(s)
- De-Kuang Hwang
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei 112, Taiwan; (D.-K.H.); (T.-C.L.); (S.-J.C.)
- School of Medicine, National Yang-Ming University, Taipei 112, Taiwan
| | - Yuh-Lih Chang
- Institute of Pharmacology, National Yang-Ming University, Taipei 112, Taiwan;
- Department of Pharmacy, Taipei, Veterans General Hospital, Taipei 112, Taiwan
| | - Tai-Chi Lin
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei 112, Taiwan; (D.-K.H.); (T.-C.L.); (S.-J.C.)
- School of Medicine, National Yang-Ming University, Taipei 112, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei 112, Taiwan;
| | - Chi-Hsien Peng
- Department of Ophthalmology, Shin Kong Wu Ho-Su Memorial Hospital & Fu-Jen Catholic University, Taipei 24352, Taiwan;
| | - Ke-Hung Chien
- Institute of Clinical Medicine, National Yang-Ming University, Taipei 112, Taiwan;
- Department of Ophthalmology, Tri-Service General Hospital & National Defense Medical Center, Taipei 114, Taiwan
| | - Ching-Yao Tsai
- Department of Ophthalmology, Taipei City Hospital, Taipei 103, Taiwan;
| | - Shih-Jen Chen
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei 112, Taiwan; (D.-K.H.); (T.-C.L.); (S.-J.C.)
- School of Medicine, National Yang-Ming University, Taipei 112, Taiwan
| | - Kuan-Hsuan Chen
- Department of Pharmacy, Taipei, Veterans General Hospital, Taipei 112, Taiwan
- Faculty of Pharmacy, School of Pharmaceutical Sciences, National Yang-Ming University, Taipei 112, Taiwan
- Correspondence: (K.-H.C.); (M.-Y.H.)
| | - Min-Yen Hsu
- Department of Ophthalmology, Chung Shan Medical University Hospital, Taichung 402, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Biotechnology Center, National Chung Hsing University, Taichung 402, Taiwan
- Correspondence: (K.-H.C.); (M.-Y.H.)
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An inhibitor of endothelial ETS transcription factors promotes physiologic and therapeutic vessel regression. Proc Natl Acad Sci U S A 2020; 117:26494-26502. [PMID: 33020273 DOI: 10.1073/pnas.2015980117] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
During the progression of ocular diseases such as retinopathy of prematurity and diabetic retinopathy, overgrowth of retinal blood vessels results in the formation of pathological neovascular tufts that impair vision. Current therapeutic options for treating these diseases include antiangiogenic strategies that can lead to the undesirable inhibition of normal vascular development. Therefore, strategies that eliminate pathological neovascular tufts while sparing normal blood vessels are needed. In this study we exploited the hyaloid vascular network in murine eyes, which naturally undergoes regression after birth, to gain mechanistic insights that could be therapeutically adapted for driving neovessel regression in ocular diseases. We found that endothelial cells of regressing hyaloid vessels underwent down-regulation of two structurally related E-26 transformation-specific (ETS) transcription factors, ETS-related gene (ERG) and Friend leukemia integration 1 (FLI1), prior to apoptosis. Moreover, the small molecule YK-4-279, which inhibits the transcriptional and biological activity of ETS factors, enhanced hyaloid regression in vivo and drove Human Umbilical Vein Endothelial Cells (HUVEC) tube regression and apoptosis in vitro. Importantly, exposure of HUVECs to sheer stress inhibited YK-4-279-induced apoptosis, indicating that low-flow vessels may be uniquely susceptible to YK-4-279-mediated regression. We tested this hypothesis by administering YK-4-279 to mice in an oxygen-induced retinopathy model that generates disorganized and poorly perfused neovascular tufts that mimic human ocular diseases. YK-4-279 treatment significantly reduced neovascular tufts while sparing healthy retinal vessels, thereby demonstrating the therapeutic potential of this inhibitor.
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Cheng Y, Zhu X, Linghu D, Xu Y, Liang J. Serum levels of cytokines in infants treated with conbercept for retinopathy of prematurity. Sci Rep 2020; 10:12695. [PMID: 32728160 PMCID: PMC7391743 DOI: 10.1038/s41598-020-69684-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 07/06/2020] [Indexed: 01/28/2023] Open
Abstract
Intravitreal anti-vascular endothelial growth factor (VEGF) agents have revolutionized the treatment of retinopathy of prematurity (ROP); however, there are concerns regarding the potential systemic complications caused by those treatments. This study aimed to determine the serum concentrations of cytokines in infants with ROP and to evaluate the changes in serum VEGF concentrations after intravitreal conbercept (IVC). Sixty infants with ROP treated with IVC 0.25 mg were included. Blood samples were collected before treatment as well as 1 week and 4 weeks after treatment. Serum levels of 45 types of cytokines were measured by a multiplex bead assay. We observed that IVC 0.25 mg in ROP patients suppressed the circulating levels of VEGF-A and VEGF-D as of 1 week after injection, and these growth factor levels returned to baseline at 4 weeks. No significant differences were observed in the serum levels of the other cytokines between baseline and 1 or 4 weeks after IVC.
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Affiliation(s)
- Yong Cheng
- Department of Ophthalmology and Clinical Centre of Optometry, Peking University People's Hospital, Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Xuemei Zhu
- Department of Ophthalmology and Clinical Centre of Optometry, Peking University People's Hospital, Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Dandan Linghu
- Department of Ophthalmology and Clinical Centre of Optometry, Peking University People's Hospital, Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Yongsheng Xu
- Department of Ophthalmology and Clinical Centre of Optometry, Peking University People's Hospital, Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China.,Clinical Stem Cell Research Center, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China
| | - Jianhong Liang
- Department of Ophthalmology and Clinical Centre of Optometry, Peking University People's Hospital, Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China.
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